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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 5, 2020 <br />Department <br />Name Jeff Hudak Central Services <br />BPW Date October 13, 2020 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />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 />❑ 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 />❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE ❑ <br />Completed E-Verify Form Attached ❑ Nos <br />Spec M - Three (3) More or Less 2020 or Newer Front Wheel Drive Cargo <br />VanUs <br />Water Works -Cash <br />622-06-604-620-445000 <br />$99,000 F Formatted: Tab stops: 0.76", Left <br />Three (3) More or Less 2020 or Newer Front Wheel Drive Cargo Van(s) <br />For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />( %) <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />( %) <br />