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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: <br />Name: <br />12.2023 <br />Daniel Sexton Department of Public Works — Engineering Division <br />BPW Date: May 23, 2023 Phone Extension: 5903 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Micheal Schmidt <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Type — Re uired or 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 />I-1 Other: I -I Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Previous Amount <br />Information <br />❑ Yes If Yes, Approved by Purchasing <br />❑ No <br />❑❑ WBE ❑ <br />Completed E-Verify Form Attached ❑ Nos <br />2023 Tree and Stump Removal <br />123-002 <br />PR-00024705 — Motor Vehicle Highway <br />202-06-602-505-431000 <br />Contractor quote for 2023 Tree and Stump Removal to facilitate internal <br />Curb and Sidewalk work. <br />❑ Increase <br />❑ Decrease <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 />