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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />July 2, 2018 <br />Department <br />Public Works <br />Name <br />Roger Nawrot <br />Division/Bureau <br />Engineering <br />BPW Date <br />July 10, 2018 <br />Phone Extension <br />5932 <br />Agreement a Contract <br />Professional Services F I Resolution <br />❑ Bid Opening <br />❑ Quote Opening <br />® Change Order No <br />❑ Ease/Encroach. <br />n Other: <br />Proposal U Addendum <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Award <br />2 ❑ CIO & PCA No. ❑ PCA <br />❑ Traffic Control: <br />Company or Vendor Name Indiana Department of Transportation <br />New Vendor <br />U Yes LJ No Ll If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Boland Trail R-36881 <br />Project Number <br />113-047 <br />Funding Source <br />Special LOIT _ <br />Account No. <br />257-0608-431.42-96 <br />Amount <br />-$29,953.32 <br />Terms of Contract <br />80% and City 20% <br />Purpose/Description <br />_Federal _ <br />This change order is for changing the allowing the Road Closure <br />Time by 30 days for public safety and increased Contractor <br />efficiencies. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />® Decrease $ 29,953.32 <br />Previous Amount $ 1,163,781.52 <br />Current Percent of Change: -2.57% <br />New Amount <br />1.133.828.20 <br />Total Percent of Change: -2.57% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Roger Nawrot <br />❑ ❑ <br />