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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/6/2023 <br />Name Scott Kreeger <br />Department Public <br />Works <br />BPW Date 6/13/2023 Phone Extension 9245 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Michael Schmidt <br />Dept. Attorney Attorney Name <br />Purchasing Mickey Lovy <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 2023 Contractor Paving Round 2 <br />Project Number 123-024 (PR-25457) <br />Funding Source River West TIF, Southside TIF, West Washington TIF <br />Account No. 324-10-102-121-442001, 430-442001, 422-442001 <br />Amount <br />Terms of Contract <br />Purpose/Description 1st Ad: June 16 <br />2nd Ad: June 23 <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 />June 13, 2023