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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 3/11/2025 <br />Name: Gemma Stanton Department of Public Works — Engineering Division <br />BPW Date: 3/25/2025 Phone Extension: 9083 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael 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 <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ® PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />❑ Other: ❑ Ease./Encroach <br />Reauired 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 />Purpose/Description <br />Premium Concrete <br />❑ Title Sheet <br />U Yes❑ If Yes, Approved by Purchasing <br />® No <br />MBE <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />2023 Curb & Sidewalk <br />123-001 <br />Motor Vehicle Highway / Major Moves <br />202-06-602-505-431000 / 412-06-600-506-431000 <br />Division A - $55,159.10; Division B - $330,167.35; Division C — <br />$243,834.34; Division D - $164,367.88; Division E - $163,445.90 <br />Project closeout (PCA and waiver of lien) <br />For Chan e Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease <br />Increase % <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />