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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 19, 2017 <br />Name Jacob M. Klosinski Department Utilities - Wastewater <br />BPW Date September 26, 2017 Phone Extension 574 235-9496 <br />`Re aired Prior to Submitfial to'Bbard <br />Legal ® Attorney Name Catherine Fanello <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 ® Carol Kurzhal <br />Company or Vendor Name <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Supplemental Easement Agreement with Indiana Michigan Power <br />Project Name Company <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />A Supplemental Easement Agreement between the City of South <br />Bend and Indiana Michigan Power Company addresses an update <br />to existing easements at the intersection of Calvert Street and <br />Renewable Drive. Utilities submits a favorable recommendation. <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />❑ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ❑ Al Greek, Director of Utilities <br />® ❑ Jacob M. Klosinski, Assistant City Engineer <br />® ❑ Carol Kurzhal, Director of Financial Services, Environmental Services <br />