HomeMy WebLinkAboutUtility Easement - 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: 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 Easements for municipal sanitary sewer, storm sewer, and water main
in the vacated Bartlett St. ROW
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: