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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />July 2, 2018 <br />Roger Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />LJ Agreement LJ Contract Proposal H Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />® Change Order No. 4 ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />I-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Indiana Department of Transportation <br />U Yes U No Ll If Yes, Approved by Purchasing <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Boland Trail R-36881 <br />113-047 <br />Special I-OIT <br />257-0608-431.42-96 <br />$26,291.03 <br />_Federal 80% and City 20% <br />This change order is for changing the two service points to a <br />single Tesco cabinet and changing the pedestrian crossing <br />flasher at Riverside Drive to be solar powdered. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Increase $ 26,291,03 <br />Decrease $ <br />Previous Amount $ 1,133,828.20 <br />Current Percent of Change: 2.32% <br />New Amount $ 1,160,119.23 <br />Total Percent of Change: -0.32% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Roger Nawrot <br />❑ ❑ <br />