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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: <br />Name <br />6/30/2025 <br />Chin Enos Department of Public Works Division of Wastewater <br />BPW Date: 7/8/2025 Phone Extension: 5789 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney <br />Purchasing <br />X Attorney Name <br />Michael Schmidt <br />X Mickey Lovy / Ashley Rzepka <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 />TX Concrete LLC <br />U Yes U If Yes, Approved by Purchasing <br />® No <br />❑ WBE Completed E-Verify Form Attached Yes <br />❑ No <br />Storm Drain and Sidewalk Repair <br />Sewage Works Operations <br />641-06-605-514-436001 <br />$1525.75 <br />Repair of approximately ten feet of collapsed storm drain and one small <br />section so cracked sidewalk beside drain. <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 />