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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/22/2020 <br />Department <br />Name Charlotte Brach <br />En ineerin <br />BPW Date 11/10/2020 <br />Phone Extension 9246 <br />Review and Approval Required <br />Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer <br />Officer Name <br />BPW Attorney ❑ <br />Attorney Name <br />Dept. Attorney ® <br />Attorney Name <br />Sandra Kennedy <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type — Re nired or All Submissions <br />❑ <br />Professional Services Agreement <br />❑ Contract <br />❑ Proposal <br />❑ <br />Open Market Contract <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ <br />Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ Reject Bids/Quotes <br />❑ <br />Proposal Opening <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ <br />Chg. Order, No. <br />❑ Traffic Control <br />❑ Resolution <br />® <br />Other: Partial Easement <br />❑ Ease./Encroach <br />Information <br />Company or Vendor Name Five Comers, LLC <br />New Vendor ❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name Five Corners, LLC Development <br />Project Number DP20-002 <br />Funding Source NA <br />Account No. NA <br />Amount NA <br />Terms of Contract NA <br />Purpose/Description Reduction in the size of an existing utility easement to accommodate <br />development of the property on the SE corner of Corby and South Bend <br />Avenue by Five Corners, LLC <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 />Decrease <br />Increase <br />Decrease <br />