Change Order No. 4 - Olive St & Sample St. Reconstruction - Lawson-Fisher - INDOT

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date October 27, 2016 Department Public Works Name Roger Nawrot Division/Bureau Engineering BPW Date November 8, 2016 Phone Extension 5932 Required Prior to Submittal to Board Legal ❑ Attorney Name: Controller El greater review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ❑ Check the Appropriate Item Type — Required for All Submissions ❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum ❑ Professional Services ❑ Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ® Change Order No. 4 ❑ C/O & PCA No. ❑ PCA ❑ Ease/Encroach. ❑ Traffic Control: ❑ Other: Required Information Company or Vendor Name Indiana Department of Transportation ❑ Yes LJ No ❑ If Yes, Approved by New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Amount of Increase Decrease Previous Amount Current Percent of Change: New Amount Total Percent of Chanae: II MBE U WBE El No ❑ Yes Name of Company Olive Street and Sample Street Reconstruction Major Moves 412-0414 /542.03 t-eaerai tsu%, city 1u% tic County 10% This change order is for changing the Intermediate Completion Date from November 1, 2016 until May 26, 2017 for the opening of Olive Street north of Sample Street. This is being done for the safety of the motoring public because the roundabout is only partially built. Traffic and Lighting division is in agreement with LJ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) Orders O Copy Origin ® ❑ Nawrot