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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 23, 2021 <br />Name Scott Kreeger <br />Department Public <br />Works <br />BPW Date March 9, 2021 Phone Extension 9245 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <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 2021 Contractor Paving Round 1 <br />Project Number 121-016 <br />Funding Source Capital Outlay-Infrastructure-Streets & Alleys <br />Account No.455-06-600-506-442001 <br />Amount <br />Terms of Contract <br />Purpose/Description _1st Ad: March 19; 2nd Ad: March 26__________________________ <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: