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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/22/17 <br />Name Roger Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 1/9/18 Phone Extension 5932 <br />U Agreement <br />Lj Contract Lj Proposal U Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />® Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control: <br />R Other: <br />Company or Vendor Name <br />Indiana Department of Transportation <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEANBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Lincoln SRTS Contract R-38062 <br />Project Number <br />114-078 <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Time extension to April 27, 2018 due to include spring inspection <br />of trees that were installed after the fall planting date. Trees will <br />be replaced if necessary. <br />n Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of H Increase <br />❑ Decrease <br />Copy Original <br />® ❑ Roger Nawrot <br />❑ ® Kyle Silveus, Troyer Group <br />❑ ❑ <br />