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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/21/2020 <br />Name Pam Mever Department DCI <br />BPW Date 4/28/2020 Phone Extension 5845 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ Officer Name Michael Patton <br />and Inclusion Officer <br />BPW Attorney ® Attorney Name <br />Clara McDaniels <br />Dept. Attorney ® Attorney Name Sandra Kennedy <br />Purchasing ❑ Michael Schmidt <br />Check the Appropriate Item Type — Re uired or 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 <br />Sheet <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />171 Other: Use Agreement <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 />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />n Ease./Encroach <br />Department of Communitv Investment <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />E] MBE <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Use of paved area for meal provision during COVID <br />N/A <br />N/A <br />N/A <br />4/23/20 <br />Purpose/Description Provides for temporary use of a specific paved area for Hope Ministries <br />meal provision during COVID. Partnering with VPA for tables, chairs <br />and trash; based on DoH recommendation for social distancing <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Increase % <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 />