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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 11 /7/2024 <br />Name: Leslie Biek, PE <br />Department of Public Works — Engineering Division <br />BPW Date: 11/12/2024 <br />Phone Extension: 9323 <br />Required Prior to Submittal to Board <br />BPW Attorney X <br />Attorney Name <br />Dept. Attorney ❑ <br />Attorney Name <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type <br />— Required. for All Submissions <br />❑ Professional Services Agreement <br />❑ Open Market Contract <br />❑ Bid Opening <br />® Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />❑ Other: <br />❑ Contract ❑ Proposal <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Award ❑ Reject Bids/Quotes <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control ❑ Resolution <br />❑ Ease./Encroach <br />Required Information <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 />Special Contract Provisions <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached El Nos <br />2024 Electric Vehicle Supply Equipment (EVSE) Installation <br />124-052 <br />PR-00036757 <br />Estimated to be $ <br />90 days from NTP for completion <br />Purpose/Description Installation of 12 EVSE charging units provided by the City at multiple <br />locations in addition to the restriping of existing EV parking spaces within the <br />City. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />Decrease <br />Increase <br />Decrease <br />