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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Apri12, 2021 <br />Department Public <br />Name Scott <br />BPW Date April 13, 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 />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 />Purpose/Description <br />Information <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />E] MBE <br />❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />2021 Street and Sewer Material Bid <br />121-018 <br />MVH R, MVH NR, MVH Curb & Sidewalk, Sewer Insurance, Sewage <br />Ops & Maint., Sewer Concrete, Water Works, Parks <br />266-06-602-503-422018, 202-06-602-503-423003, 202-06-602-505- <br />423003, 640-06-602-510-422000/423005, 641-06-602-509-423002, 641- <br />06-602-511-422000/423005, 620-06-604-606-423007, 201-11-201-201- <br />439000 <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease ( %) <br />Increase % <br />Total Percent of Change: Decrease ( %) <br />Time Extension Amount: <br />