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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10.17.22 <br />Name Joseph Molnar Department DCI <br />BPW Date 10.25.22 Phone Extension 6022 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer Officer Name <br />BPW Attorney Attorney Name Sandra Kennedy <br />Dept. Attorney Attorney Name Danielle Campbell Weiss <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: Access Agreement Ease./Encroach <br />Required Information <br />Company or Vendor Name Rescue Incorporated d/b/a Hope Ministries <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor MBE <br />WBE <br />Completed E-Verify Form Attached Yes <br /> No <br />Project Name Temporary Access Agreement-510 S. Main Street <br />Project Number <br />Funding Source N/A <br />Account No. N/A <br />Amount N/A <br />Terms of Contract October 25, 2022-April 30, 2023 <br />Purpose/Description Access to property to conduct weather amnesty services <br />For Change Orders Only <br />Amount of 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: