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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 17, 2025 <br />Name Carl R. Buchanon, Fire Chief Department Fire <br />BPW Date 1/28/25 Phone Extension 9255 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer Officer Name <br />BPW Attorney ❑ Attorney Naive <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />I Check the Appropriate Item Type — Required far 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 Sheei <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ® Resolution No. 03-2025 <br />J] Other: _ 0-Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Naive <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Information <br />❑ Yes[] If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Disposal of Unfit and/or Obsolete Property. Helmets and boots for Retire, <br />Suzanne Krill <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 />