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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: April 25, 2024 <br />Name: Chana Roschyk, Project Engineer Department of Public Works — Engineering Division <br />BPW Date: May 14, 2024 Phone Extension: 5922 <br />Required Prior to Submittal to Board <br />Diversity Compliance ® Officer Name Darius Lipsey <br />and Inclusion Officer <br />BPW Attorney ® Attorney Name Michael Schmidt <br />Dept. Attorney ® Attorney Name Michael Schmidt <br />Purchasing ❑ <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 />❑ Other: ❑ Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />❑ Yes[:] If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBE Yes <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ BE ❑ No <br />Project Name <br />High Street Sidewalk Improvements <br />Project Number <br />123-012 DFO: PROJ00000410 - High Street Improvements <br />Funding Source <br />South Side Redevelopment Area TIF <br />Account No. <br />PR/PO # PR-00032838 <br />Amount <br />Terms of Contract <br />Special Contract Provisions <br />Purpose/Description <br />Request to open bids for project 123-012 High Street Sidewalk Improvement, <br />For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />$ <br />Increase % <br />Total Percent of Change: <br />Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />