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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 17, 2025 <br />Name Carl R. Buchanon, <br />Fire Chief Department Fire <br />BPW Date 1/28/25 <br />Phone Extension 9255 <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 ❑ <br />Attorney Naive <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type —Required for All Submissions <br />❑ Professional Services Agreement <br />❑ Contract ❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheei <br />❑ Quote Opening <br />❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control ® Resolution No. 07-2025 <br />❑ Other: <br />❑ Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />❑❑ <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Disposal of Unfit and/or Obsolete Property. Helmets and boots for Retire, <br />Ron Simons <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />( % <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />( % <br />Time Extension Amount: <br />New Completion Date: <br />