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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 5, 2020 <br />Name Jacob M. Klosinski <br />Department <br />Engineering/Utilities <br />BPW Date October 13, 2020 Phone Extension Ext. 9496 <br /> <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer Officer Name Michael Patton <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Clara McDaniels <br /> <br />Purchasing Michael Schmidt <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 Title Sheet <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: Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />New Vendor Yes If Yes, Approved by Purchasing <br />No <br />MBE/WBE Contractor MBE <br />WBE Completed E-Verify Form Attached Yes <br />No <br />Project Name WWTP Masonry Improvements Gallery Buildings 1-4 <br />Project Number 120-036 <br />Funding Source Sewage Works Building Repair and Maintenance Account <br />Account No. 641-06-605-514-436001 (PROJ00000217; PR-00003823) <br />Amount <br />Terms of Contract <br />Purpose/Description The Division of Engineering and Division of Utilities requests the Board of <br />Public Works open and receive bids for the subject project. Refer to <br />Memorandum for project details (attached). <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br />% <br />(%) <br /> New Amount $ <br />Total Percent of Change: <br />Increase <br />Decrease <br />% <br />(%) <br /> Time Extension Amount: <br />New Completion Date: