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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 2, 2018 Department Public Works <br />Name Roger Nawrot Division/Bureau Engineering <br />BPW Date July 10, 2018 Phone Extension 5932 <br />Legal ❑ Attorney Name: <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 />H Agreement <br />H Contract H Proposal j j 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. 6 <br />_ <br />El <br />C/O & PCA No. ❑j PCA <br />❑ Ease/Encroach. <br />❑ <br />Traffic Control: <br />F Other. - <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />PurposelDescription <br />Amount of <br />Indiana Department of Transportation <br />Boland Trail R-36881 <br />113-047 <br />Special LOIT <br />257-0608-431.42-96 <br />$2,750.00 <br />Federal 80% and City 20% <br />This change order is for adding a gate for the St. Joseph County <br />access to their Cemetery off of Boland Drive. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Nan -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Increase $ 2,750.00 <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />❑ <br />$ 1,348,484.17 <br />0.20% <br />$ 1,351,234.17 <br />16.10% <br />Dispersal After Approval <br />Roaer Nawrot <br />