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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/9/2024 <br />Department Public <br />Name Lidva Abreha <br />BPW Date 5/28/2024 Phone Extension 5961 <br />Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Michael Schmidt <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />❑ Mickey Lovy <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 />❑ Other: ❑ Ease./Encroach <br />Information <br />Company or Vendor Name <br />New Vendor ❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑MBE Completed E-Verify Form Attached <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />❑ WBE <br />2024 Brick Spot Ref <br />124-041 (PR-33529) <br />Local Road & Street <br />408-06-602-503-436008 <br />❑ Yes <br />❑ No <br />For Change Orders Only Ogg <br />Amount of ❑ Increase $ <br />El 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 <br />