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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 11/26/2024 <br />Name: Gemma Stanton Department of Public Works — Engineering Division <br />BPW Date: 12/10/2024 Phone Extension: 9083 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Type — Re uired or All Submissions <br />❑ <br />Professional Services Agreement ❑ Contract <br />❑ <br />Proposal <br />❑ <br />Open Market Contract ❑ Amendment/Addendum <br />❑ <br />Special Purchase, QPA <br />❑ <br />Bid Opening ❑ Bid Award <br />❑ <br />Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening ❑ Quote Award <br />❑ <br />Reject Bids/Quotes <br />❑ <br />Proposal Opening ❑ C/O & PCA No. 1 <br />❑ <br />PCA <br />® <br />Chg. Order, No. 1 & Final ❑ Traffic Control <br />❑ <br />Resolution <br />❑ <br />Other: <br />❑ <br />Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />Premium Concrete <br />New Vendor <br />❑ Yes❑ If Yes, Approved by Purchasing <br />® No <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ Nos <br />MBE ❑ <br />Project Name <br />2023 Curb & Sidewalk <br />Project Number <br />123-001 <br />Funding Source <br />202-06-602-505-431000 / 412-06-600-506-431000 <br />Division A - $64,949; Division B - $335,583; Division C — $246,378; <br />Account No. <br />Division D - $157,478; Division E - $169,030 <br />Amount <br />See attached memo <br />Terms of Contract <br />Unit Price <br />Purpose/Description <br />CO #1 and Final for 2023 Curb and Sidewalk <br />For Change <br />Orders Only <br />Amount of ❑ <br />Increase $ See attached memo <br />❑ <br />Decrease ($ <br />) <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />( %) <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />( %) <br />Time Extension Amount: <br />New Completion Date: <br />