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Date: 10/14/2024 <br />Name: Gemma Stanton Department of Public Works — Engineering Division <br />BPW Date: 10/22/2024 Phone Extension: 9083 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Type — Re uired 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 />❑ Other: M Ease./Encroach <br />Information <br />Company or Vendor Name <br />Robert Henry Corporation <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBE] Yes <br />MBE/WBE Contractor <br />❑ E Completed E-Verify Form Attached ❑ No <br />Project Name <br />Robert Henry Facility 3161 Youngs Ct <br />Project Number <br />DP23-038 <br />Funding Source <br />N/A <br />Account No. <br />N/A <br />Amount <br />N/A <br />Terms of Contract <br />N/A <br />Purpose/Description <br />Easement for public water main along Renewable Energy Drive <br />through private property at 3161 Youngs Ct. <br />For Change Orders Only <br />Amount of Increase $ <br />Previous Amount <br />❑ Decrease <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 />