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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/07/2023 <br />Name Patrick Sherman <br />Department VPA <br />BPW Date 03/14/2023 <br />Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer <br />Officer Name <br />BPW Attorney ® <br />Attorney Name <br />Michael Schmidt <br />Dept. Attorney ❑ <br />Attorney Name <br />Purchasing ® <br />Mickey Lovey <br />Check the Appropriate <br />Item Type <br />— Re uired or All Submissions <br />❑ Professional Services Agreement <br />❑ Open Market Contract <br />❑ Bid Opening <br />® Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />❑ Other: <br />❑ Contract ❑ Proposal <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Award ❑ Reject Bids/Quotes <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control ❑ Resolution <br />❑ Ease./Encroach <br />Reauired Information <br />Company or Vendor Name <br />TBD <br />❑ Yes[:] If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />❑❑ MBYes <br />MBE/WBE Contractor <br />E Completed E-Verify Form Attached ❑ <br />No <br />Project Name <br />Century Center Parking Lot Seal and Stripe <br />Project Number <br />122-060B <br />Funding Source <br />Hotel Motel Tax <br />Account No. <br />County Fund 7304 <br />Amount <br />TBD <br />Terms of Contract <br />Unit Price <br />Purpose/Description <br />_Seal and stripe of Century Center Parking lot including limited asphalt <br />repair. <br />For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />$ <br />Increase % <br />Total Percent of Change: <br />Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />