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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 5, 2020 <br />Department <br />Name Jacob M. Klosinski EnOneerim/Utilities <br />BPW Date October 13, 2020 Phone Extension Ext. 9496 <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 <br />Dept. Attorney ❑ <br />Purchasing ❑ <br />Check the <br />Clara McDaniels <br />Attorney Name Clara McDaniels <br />Michael Schmidt <br />to Item Tvbe — Reauired for All Submissions <br />U Professional Services Agreement U Contract U 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 />n Other: n Ease./Encroach <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 />Information <br />Yes U If Yes, Approved by Purchasing <br />No <br />❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />WWTP Masonry Improvements Gallery Buildings 1-4 <br />120-036 <br />Sewage Works Building Repair and Maintenance Account <br />641-06-605-514-436001 (PROJ00000217; PR-00003823) <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 ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />Decrease <br />Increase <br />Decrease <br />