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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/09/2024 <br />Name Zach Hurst Department DPW <br />BPW Date 10/22/2024 Phone Extension 3057 <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 ❑ 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. IIFI <br />I-1 Other: <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 />❑ Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />Green Demolition <br />All Submissions <br />U Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />Yes U If Yes, Approved by Purchasing <br />® No <br />❑❑ ❑ <br />MBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Demolition of 1000 W. Sample St. — Former Fun FX Building <br />123-014R <br />ARP Funding <br />PO-00030913 <br />This change: $21,200; Revised Amount: $550,000 <br />Lump Sum <br />This final change order addresses unforeseen asbestos remediation due to <br />asbestos pipe lining buried in a basement tunnel. <br />For Change Orders Only <br />Amount of ® Increase $ 21,200 <br />❑ Decrease ($ ) <br />Previous Amount <br />$ 528,800 <br />Increase <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ 550,000 <br />Increase <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />4.01 % <br />4.01 <br />