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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 17, 2021 Department Public Works <br />Name Kyle Silveus Division/Bureau Engineering <br />BPW Date November 23, 2021 Phone Extension 9083 <br />Required Prior to Submittal to Board <br />Legal Attorney Name: Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Michael Schmidt <br />Check the Appropriate Item Type – Required for All Submissions <br /> Agreement Contract Proposal Addendum <br /> Professional Services Resolution <br /> Bid Opening Bid Award Req. to Advertise Title Sheet <br /> Quote Opening Quote Award <br /> Change Order No. C/O & PCA No. PCA <br /> Ease/Encroach. Traffic Control: <br /> Other: <br />Required Information <br />Company or Vendor Name N/A <br />New Vendor Yes No If Yes, Approved by Purchasing <br />MBE/WBE Contractor MBE WBE <br />MBE/WBE Contractor Requested No Yes Name of Company <br />Project Name Ward Bakery Exterior Renovations <br />Project Number 121-061R, PROJ00000293 <br />Funding Source River West TIF <br />Account No. 324-443001 <br />Amount N/A <br />Terms of Contract <br />Purpose/Description <br />N/A <br />Exterior Improvements to the Ward Bakery building. <br />Improvements to the façade include masonry, doors, and <br />windows. <br /> Required Contractor’s Certification Forms Attached (Non- <br />Collusion, Non-Discrimination, Non-Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ <br />$ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />Kyle Silveus <br />November 23, 2021