HomeMy WebLinkAboutDedicated Improvements Agreement - Beacon Health System Tower Project - TABLEDBOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date: 11/21/23
Name: Gemma Stanton Department of Public Works – Engineering Division
BPW Date: November 28, 2023 Phone Extension: 9083
Required Prior to Submittal to Board BPW Attorney Attorney Name Michael Schmidt
Dept. Attorney Attorney Name
Purchasing
Check the Appropriate Item Type – Required for All Submissions
Professional Services Agreement Contract Proposal
Open Market Contract Amendment/Addendum Special Purchase, QPA
Bid Opening Bid Award Req. to Advertise Title Sheet
Quote Opening Quote Award Reject Bids/Quotes
Proposal Opening C/O & PCA No. PCA
Chg. Order, No. Traffic Control Resolution
Other: Dedicated
Improvements Agreement
Ease./Encroach
Required Information
Company or Vendor Name
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE
WBE Completed E-Verify Form Attached Yes
No
Project Name N/A
Project Number N/A
Funding Source N/A
Account No.
Amount
Terms of Contract
Purpose/Description This dedicated improvements agreement ensures that the temporary
approaches to be installed for the Beacon Tower project will be
replaced with adequate curb, sidewalk, and landscaping after the
project completion.
For Change Orders Only
Amount of
Increase
Decrease
$
($ )
Previous Amount $
Current Percent of Change:
Increase
Decrease
%
( %)
New Amount $
Total Percent of Change:
Increase
Decrease
%
( %)
Time Extension Amount:
New Completion Date: