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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: <br />Name <br />4/l/2024 <br />Gemma Stanton <br />Department of Public Works — Engineering Division <br />BPW Date: April 23, 2024 Phone Extension: 9083 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />❑� <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. 1 ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: 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 />uired Information <br />❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />E] MBE ❑ WBE Completed E-Verify Form Attached El Yes <br />n No <br />Safe Routes to School — Our Lady of Hungary Neighborhood Tree <br />Removal <br />122-007B <br />PO-0029610 <br />324-10-102-121-442001—PROJ00000339 <br />Project closeout and balancing change order. <br />Amount of Increase $ <br />® Decrease ($ 1419) <br />Previous Amount $ 28,809 <br />Increase % <br />Current Percent of Change: Decrease (4.93%) <br />New Amount $ 27390 <br />Increase % <br />Total Percent of Change: Decrease (4.93%) <br />Time Extension Amount: <br />New Completion Date: <br />