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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/29/2024 <br />Naive Carl R. Buchanon <br />Fire Chief Department Fire <br />BPW Date 4/9/2024 <br />Phone Extension 9255 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ <br />Attorney Name <br />Dept. Attorney ❑ <br />Attorney Name <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type — Required_ for All Submissions <br />❑ Professional Services Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control ® Resolution No. 11-2024 <br />❑ Other: <br />❑ Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />❑ Yes[:] If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />E] MBE <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description Disposal of Unfit Property -Helmet & Boots; Retiree Assistant Chief Gerard <br />Ellis; March 9, 2024 <br />For Change Orders Only <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 />