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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 11 /4/24 <br />Name: Michael J. Schmidt Department of Public Works — Legal <br />BPW Date: 11/12/24 Phone Extension: <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name <br />Michael J. Schmidt <br />Dept. Attorney ❑ Attorney Name <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 />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 />Special Contract Provisions <br />Purpose/Description <br />Information <br />McCormick Company, Inc. <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />E] MBE <br />❑ WBE Completed E-Verify Form Attached ❑❑ Yes <br />No <br />PR/PO # <br />Resolution to re -convey a quit claim deed to McCormick Company, Inc. <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 />