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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 20, 2021 <br />Name Scott Kreeger <br />Department Public <br />Works <br />BPW Date May 11, 2021 Phone Extension 9245 <br /> <br />Required Prior to Submittal to Board BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br /> <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 Street and Sewer Material Bid <br />Project Number 121-018 <br />Funding Source <br />MVH R, MVH NR, MVH Curb & Sidewalk, Sewer Insurance, Sewage <br />Ops & Maint., Sewer Concrete, Water Works, Parks <br />Account No. <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 />Amount See Memo for breakdown. <br />Terms of Contract Unit Price <br />Purpose/Description ________________________________________________ <br />For Change Orders Only <br />Amount of <br /> <br />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: