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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/7/2021 <br />Name Charlotte Brach <br />Department <br />Engineering <br />BPW Date 7/13/2021 Phone Extension 9246 <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br /> <br />Purchasing <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 Forum Architects, LLC <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 118-091 O’Brien Recreation Renovation <br />Project Number PROJ00000057 <br />Funding Source TIF – Southside Development #1 <br />Account No. 430-10-102-121-443001-PROJ00000057 <br />Amount $1,458.31 <br />Terms of Contract Lump Sum <br />Purpose/Description PSA Amendment for O’Brien Recreation Renovation for additional <br />construction administration due to the extension of the contract time, and <br />reimbursable expenses for permits and document printing. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br /> % <br />( %) <br /> <br />New Amount $ <br />Total Percent of Change: <br />Increase <br />Decrease <br /> % <br />( %) <br /> <br />Time Extension Amount: <br />New Completion Date: