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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: December 5, 2023 <br />Name: Leslie Biek, PE Department of Public Works — Engineering Division <br />BPW Date: December 12, 2023 Phone Extension: 9323 <br />Required Prior to Submittal to Board <br />BPW Attorney X <br />Attorney Name Michael Schmidt <br />Dept. Attorney ❑ <br />Attorney Name <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type — Re uired <br />or All Submissions <br />❑ Professional Services Agreement ❑ Contract <br />❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award <br />® Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />❑ Resolution <br />❑ Other: <br />❑ Ease./Encroach <br />Reauired Information <br />Company or Vendor Name <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBE <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ Nos <br />❑ <br />Project Name <br />2023 Guardrail Installation and Replacement <br />Project Number <br />122-043R <br />Funding Source <br />PR-00022501 <br />Account No. <br />412-442001 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Opening of bids for guardrail and handrail installation at various <br />locations. <br />For Change Orders Only <br />Amount of <br />❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />