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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REQUEST FORM;, <br />Agenda Items MUST be in Original, Signed Format <br />,± <br />Please Complete All Applicahle Sections of Form <br />labs ' <br />Date June 7, 2006 <br />g <br />BPW Date June 8, 2006 <br />° <br />Name Carl Littrell <br />Department Public Works <br />Phone 5937 <br />Type of Agreement <br />Contract/Agreement <br />Company Name <br />--------------------------------- <br />William Dobslaw <br />Project Name <br />Michigan Street Reconstruction from <br />------------------------------------- <br />Ireland to Chippewa — <br />. <br />as---------- <br />Project Number (Engineering) <br />104-024 <br />o <br />Project Code (Controller) ----------------- <br />06X103 <br />Q o <br />Funding Source <br />LRSA <br />�. <br />U <br />0 <br />--------------------------------- <br />Amount ----------------------------------- <br />A <br />Purpose/Description <br />Administrativ ettlement o Real <br />o <br />sta e ransfer in Eminent Domain <br />Effective Date <br />Upon Signature & Separate Approval <br />----------- •----------------------- <br />of Variances by BZA <br />End Date <br />None - Perpetual <br />- ---- — <br />; Type of Item .------------------------- <br />Advertise <br />Company Name --------------------------------- <br />Project Name <br />...................................... <br />Project Number (Engineering) --------------- <br />Project Code (Controller) --------------------- <br />Funding Source --------------------------------- <br />Contract/Project Amount <br />$ <br />Type of Item ---------------------- <br />Change Order <br />Contractor/Consultant Name <br />Project Name <br />-------------------------------------- <br />Project Number (Engineering) <br />................ <br />! Project Code (Controller) ..................... <br />jFunding Source <br />PO Number ...................................... <br />Amount of ❑Increase ❑Decrease <br />$ <br />Original Contract/Project Amount <br />$ <br />New Contract/Project Amount <br />$ <br />Total Percent of Increase/Decrease <br />% <br />Type of Item <br />Claim <br />a°� <br />------------------------ <br />Company Name _____ <br />Project Name <br />--------------------------------- <br />Project Number (Engineering) <br />Project Code (Controller) <br />