Authorization for Entry Agreement - Authorizing Entry at 3706 W. Western Ave. for Drilling

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 7/21/2020 Department Name Charlotte Brach Engineering BPW Date 7/28/2020 Phone Extension 9246 Review and Approval Required Prior to Submittal to Board Diversity Compliance ❑ Officer Name and Inclusion Officer BPW Attorney ® Attorney Name Clara McDaniels Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type — All Submissions U Professional Services Agreement U Contract U 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: Authorization for ❑ Ease./Encroach Entry Agreement Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Information Roger L. Corner ❑ Yes ❑ If Yes, Approved by Purchasing ❑ No E] MBE ❑ WBE Completed E-Verify Form Attached ❑ Yes ❑ 3706 West Western Avenue Purpose/Description Agreement authorizing entry upon public property for drilling purposes and revocable permit for environmental remediation purposes with Roger L. Corner, for property located at 3706 West Western Avenue. For Change Orders Only Amount of ❑ Increase $ ❑ Decrease ($ ) Previous Amount $ Increase Current Percent of Change: Decrease New Amount $ Increase Total Percent of Change: Decrease Time Extension Amount: