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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 12/1/2022 <br />Name: Kelly Smith Department of Public Works <br />BPW Date: 12/13/2022 Phone Extension:5795 <br />Required Prior to Submittal to Board <br />BPW Attorney X Michael Schmidt <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. Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name <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 Bid for Six Thousand (6,000) More or Less Universal/Nestable Refuse and Yard <br />Waste Containers <br />Project Number <br />Funding Source 610-06-603-512-422000 <br />Account No. PR #00021076 <br />Amount <br />Terms of Contract Unit Prices <br />Purpose/Description Purchase of Six Thousand (6,000) More or Less Universal/Nestable Refuse and <br />Yard Waste Containers – 24- month contract. <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: <br />New Completion Date: <br />December 13, 2022