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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/15/23 <br />Name Joseph Molnar Department DCI <br />BPW Date 6/27/23 Phone Extension 6022 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name Michael Schmidt <br />Dept. Attorney ® Attorney Name <br />Purchasing ❑ <br />Danielle Campbell Weiss <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 />N Other: License Agreement n 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 />El <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Information <br />U Yes U If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />License Agreement for Temporary Use for gardening purposes <br />Sunchoke Farms is a local company which grows food on vacant lots in the <br />Near Northwest Neighborhood. Sunchoke approached the City with the <br />request to grow a garden on two city owned parcels. This agreement allows <br />them to do so while granting the City authority to revoke the access <br />agreement if at a time another development is proposed. <br />For Change Orders Only <br />Increase $ <br />Decrease ($ ) <br />Increase % <br />Decrease ( %) <br />Increase <br />Total Percent of Change: Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />