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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 19, 2020, Formatted: Font: Bold, Underline <br />Department Central <br />Name Jeff Hudak Services <br />BPW Date October 27, 2020 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name <br />BPW Attorney ❑ Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ® Michael Schmidt <br />Check the Appropriate <br />Item Type — Required. for All Submissions <br />❑ Professional Services Agreement <br />❑ Contract <br />❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />® Quote Award <br />❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. _ <br />❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />❑ Resolution <br />❑ Other: <br />El Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Pvramid Eauinment <br />❑ Yes❑ If Yes, Approved by Purchasing <br />® No <br />❑❑ MBE Completed E-Verify Form Attached ❑ NoEl <br />Spec G-One (1) or More 2020 or Newer 27 Cubic Yard Single Arm Side <br />Loading Refuse Truck <br />Solid Waste Capital Budget <br />611-06-603-512-445000 <br />135.00 <br />Spec G — One (1) or More 2020 or Newer 27 Cubic Yard Refuse Truck <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Increase <br />% <br />Decrease <br />( %) <br />Increase <br />% <br />Decrease <br />( %1 <br />