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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/13/2022 <br />Name Leslie Biek, PE Department PW <br />BPW Date 9/27/2022 Phone Extension 9323 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer Officer Name _____________ <br />BPW Attorney Attorney Name _____________ <br />Dept. Attorney Attorney Name _____________ <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. 1 and Final Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name Milestone Contractors North, Inc. <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 Sample and Mayflower Intersection Improvements <br />Project Number 120-052R <br />Funding Source <br />Account No. PO-10526 <br />Amount <br />Terms of Contract <br />Purpose/Description Final balancing change order. ______________________________________ <br />______________________________________________________________ <br />For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ <br />($ 9168.61) <br />Previous Amount $ 347,636.15 <br />Current Percent of Change: <br />Increase <br />Decrease <br />% <br />(2.64%) <br /> New Amount $ 338,467.54 <br />Total Percent of Change: <br />Increase <br />Decrease <br />% <br />(2.64%) <br />Time Extension Amount: <br />New Completion Date: