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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/14/2022 <br />Name Toy Villa Department Public Works <br />BPW Date 09/27/2022 Phone Extension 5920 <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. 1 final PCA <br /> Chg. Order, No. Traffic Control Resolution <br /> Other: Ease. /Encroach <br />Required Information <br />Company or Vendor Name National Pavement Maintenance <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 2022 Microsurfacing <br />Project Number 122-011 <br />Funding Source PROJ0000000337 / PR-00017892 <br />Account No. Infrastructure Bond <br />Amount $69,760.00 <br />Terms of Contract <br />Purpose/Description _Project Closeout <br />For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ <br />($ 3,150.00) <br />Previous Amount $ 72,910.00 <br />Current Percent of Change: <br />Increase <br />Decrease <br />% <br />(4.32%) <br /> New Amount $ 69,760.00 <br />Total Percent of Change: <br />Increase <br />Decrease <br />% <br />(4.32%) <br />Time Extension Amount: <br />New Completion Date: