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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/20/16 <br />Name Toy Villa —21�7 Department Engineering <br />BPW Date 09/27/16 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Re to Advertise <br />❑ Quote Opening ❑ Quote Award q ❑Title Sheet <br />® Change Order No. 7 ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Required Inform, <br />Reith Riley Construction <br />Yes No t <br />❑ MBE ❑ WBE <br />LJ No LJ Yes Name of Company <br />South Bend One Way to Two Way Conversion — Division B <br />116-001 <br />2015 TIF <br />Approval of Change Order #7 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Amount of N Increase <br />❑ Decrease <br />Previous Amount $ 16 <br />Current Percent of Change: 1.73 <br />New Amount $ 17 <br />Total Percent of Change: 6.92 <br />Copy <br />Original <br />® <br />❑ <br />Michael Divita <br />am - <br />ired For Change Orders Only <br />293,073.61 <br />54,944.70 <br />48,018.31 <br />)ispersal After Approval <br />Beth Leonard, Judy Love <br />