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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 4/l/2024 <br />Name: Gemma Stanton Department of Public Works — Engineering Division <br />BPW Date: 4/9/2024 Phone Extension: 9083 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />❑� <br />Check the Appropriate Item Type — Required. for 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: ❑ Ease./Encroach <br />uired Information <br />Company or Vendor Name <br />Ortiz Construction <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached No <br />Project Name <br />Dubail Street Sidewalk <br />Project Number <br />124-009B <br />Funding Source <br />PR-00032458 <br />Account No. <br />202-06-602-505-431000-PROJ00000514 <br />Amount <br />$13,676 <br />Terms of Contract <br />Lump Sum <br />Purpose/Description <br />Award quote for Dubail Street sidewalk construction to Ortiz <br />Construction for $13,676 <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 Completion Date: <br />Increase % <br />Decrease ( %) <br />Increase % <br />Decrease ( %1 <br />