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Date: <br />Name: <br />BPW Date: <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />6/2/2025 <br />Gemma Stanton Department of Public Works — Engineering Division <br />6/10/2025 <br />Phone Extension: 9083 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name <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 />Information <br />Company or Vendor Name Selge Construction <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />L] MBE ❑ WBE Completed E-Verify Form Attached El No <br />2025 Curb and Sidewalk Program <br />125-001 <br />Motor Vehicle <br />PR-00041142 <br />Amount $1,364,781.90 <br />Terms of Contract Unit price <br />Special Contract Provisions N/A <br />Purpose/Description Request to award base bid and both alternates to Selge Construction <br />For Change 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 />