Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 06/17/2025 <br />Name: Patrick Sherman Department of Public Works — Engineering Division <br />BPW Date: 06/24/2025 Phone Extension: 5601 <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 ❑ 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 />Milestone Contractors <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />[I MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />Leeper Ave. Bridge Repairs Deck Replacement <br />124-008 <br />201-11-201-201-436001 <br />PO # 33849 <br />$520,965.85 <br />Public Bid <br />Project Completion Affidavit and Waiver of Lien for the project. <br />For Change Orders Only <br />Amount of ❑ Increase <br />❑ Decrease ($ ) <br />Previous Amount <br />Increase 5 <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 />