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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/9/2021 <br />Name Leslie Biek, PE Department PW <br />BPW Date 2/23/2021 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer Officer Name Larry King <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing Ron O’Connor <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 Sample and Mayflower Intersection Improvements <br />Project Number 120-052 <br />Funding Source 2020 Signal funding and Capital Outlay-Infrastructure-Streets & Alleys <br />Account No. 251-436010 ($200,000) and 455-06-600-506-442001 (remainder) <br />Amount Estimated $321,200 <br />Terms of Contract <br />Purpose/Description _Request to Advertise the Sample and Mayflower project. Advertisement <br />dates are 2/26/21 and 3/5/21 with bids to be opened at the 3/9 BPW meeting. <br />______________________________________________________________ <br />For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ <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: