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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/30/2025 <br />Name Dan Jones <br />Department Public Works <br />BPW Date 8/12/2025 <br />Phone Extension 9245 <br />Required Prior to Submittal to Board <br />BPW Attorney ❑ <br />Attorney Name <br />Michael Schmidt <br />Dept. Attorney ❑ <br />Attorney Name <br />Purchasing ❑ <br />Mickey Low <br />Check the Appropriate <br />Item Type <br />— Re uired or All Submissions <br />❑ Professional Services Agreement <br />❑ Contract <br />❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />® Quote Award <br />❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />❑ Resolution <br />n Other: <br />n Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />National Pavement Maintenance <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />Yes <br />MBE <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ <br />❑ <br />Project Name <br />2025 Microsurfacing Quote <br />Project Number <br />125-042 <br />Funding Source <br />PR-42067 <br />Account No. <br />251-431000, 251-436008 <br />Amount <br />$94,870.00 <br />Terms of Contract <br />Purpose/Description <br />Award of 2025 microsurfacing quote. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />Decrease <br />Increase <br />Decrease <br />