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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07/29/2024 <br />Name Rebecca Maenhout Department Public Works <br />BPW Date 08/06/2024 Phone Extension 5996 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney ® Attorney Name Michael Schmidt <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ® Mickey Lovy <br />Check the Appropriate Item Type — <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />n Other: <br />❑ Amendment/Addendum <br />❑ Bid Award <br />® Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />U Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />Company or Vendor Name <br />DB Custom Curbs <br />❑ Yes[:] If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />Yes <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached ❑ <br />No <br />Project Name <br />Repair to Curbing at Erskine Golf Course <br />Project Number <br />N/A <br />Funding Source <br />PR-00034618 <br />Account No. <br />201-11-202-221-436000-- <br />Amount <br />$3.920.00 <br />Terms of Contract <br />Lump Sum Quote <br />Purpose/Description <br />A customer tripped on broken asphalt curbing at Erskine Golf Course and <br />broke their wrist. This is to remove the curbing and replace with concrete, <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 Comaletion Date: <br />