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Date 8/4/2020 <br />Department <br />Name Sue Ellen Doudrick Engineering <br />BPW Date 8/11/2020 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ® Attorney Name Clara McDaniels <br />Purchasing ❑ <br />Check the Appropriate Item Type —Required 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 Sheet <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: M Ease./Encroach <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 />Purpose/Description <br />Information <br />Christopher J. Voros and Jennifer N. Morse-Voros Revocable Trust — <br />TEMPORARY AND PERMANENT EASEMENT <br />Yes If Yes, Approved by Purchasing <br />❑ No <br />El MBE <br />❑ WBE Completed E-Verify Form Attached ❑❑ Yes <br />No <br />Prairie Avenue Water Main Loop <br />117-068 <br />TIF Southside Development 41 <br />Fund 430 <br />$5,000 <br />Iumr) sum <br />The easements are needed for construction access and installation of the <br />proposed water main. <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 Combletion Date: <br />Increase % <br />Decrease ( %) <br />Increase % <br />Decrease ( % <br />