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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/18/2024 <br />Name Carl Buchanon, Fire Chief Department Fire <br />BPW Date 02/13/2024 Phone Extension 9255 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ Officer Name Cynthia Simmons <br />and Inclusion Officer <br />BPW Attorney <br />❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item I <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />I -I Other: <br />Michael Schmidt <br />❑ Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />U Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />X Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />❑ Yes[:] If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />Yes <br />MBE <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ ❑ No <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Disposal of surplus property Helmet and Boots for Retirees: Craig Fruth, <br />Randy Newman, Shannon Pohl, and Eric Purcell <br />For Change Orders Onl <br />Amount of ❑ 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 />