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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/26/20 <br />Department <br />Name Kyle Silveus Engineering <br />BPW Date 10/27/20 Phone Extension 9083 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ® Attorney Name Sandra Kenned <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required. for All Submissions <br />❑ Professional Services Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />® Other: Dedicated ❑ Ease./Encroach <br />Improvements and Draiange <br />Information <br />❑ Title Sheet <br />Company or Vendor Name <br />Five Corners, LLC <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />❑ <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ WBE ❑ Nos <br />Project Name <br />Five Corners, LLC Development <br />Project Number <br />DP19-036 <br />Funding Source <br />N/A <br />Account No. <br />N/A <br />Amount <br />TBD <br />Terms of Contract <br />Purpose/Description <br />Dedicated Improvements Agreement for Ally Improvements with a related <br />Drainage Agreement <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Increase % <br />Decrease ( % <br />Increase % <br />Total Percent of Change: <br />Decrease <br />