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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/12/2023 <br />Name Becca Plantz Department Public Works <br />BPW Date 12/19/2023 Phone Extension 5998 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name <br />BPW Attorney <br />❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Tvne — <br />Michael Schmidt <br />red for All Submissions <br />U Professional Services Agreement U Contract U 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: n Ease./Encroach <br />Information <br />Company or Vendor Name <br />Milestone Contractors North, Inc. <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />s <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ N <br />❑ WBE <br />Project Name <br />Bercliff Estates Sewer Separation <br />Project Number <br />122-016C <br />Funding Source <br />Stormwater Infrastructure <br />Account No. <br />PR-28733 <br />Amount <br />$662,940.00 <br />Terms of Contract <br />Unit Prices <br />Purpose/Description <br />Sewer separation in the Bercliff Estates neighborhood for drainage <br />improvements. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease ( % <br />Increase % <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />New Completion Date: <br />