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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1019/2018 Department Public Works <br />Name <br />Sue Ellen Doudrick <br />Division/Bureau <br />Engineering <br />BPW Date <br />10/9/18 <br />Phone Extension <br />5992 <br />I <br />Legal F-11 Attorney Name: Clara McDaniels <br />Controller review is required for all Contracts $5,000,00 or more and <br />Controller El greater than one year in length per the City Purchasing Policy <br />Purchasing F Michael Schmidt <br />LJ Agreement Amendment <br />H Contract L] Proposal Ll Addendum <br />F-I Professional Services <br />n Resolution <br />F-1 Bid Opening <br />n <br />Bid Award ❑ Req. to Advertise El Title Sheet <br />M Quote Opening <br />Z <br />Quote Award <br />E] <br />Change Order No. <br />F-1 C/O & PCA No. El PCA <br />Ease/Encroach. <br />❑ Traffic Control: <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/BE 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 />Purpose/Description <br />Airmarking <br />E] Yes Z No If Yes, Approved by <br />Purchasing <br />E]­MBE El WBE <br />El No El Yes Name of Company <br />Bike Parkin Areas <br />118-059R <br />Complete Streets Transportation <br />404-1001-460-42.03 <br />$9,800 <br />Unit Prices <br />Installation of bike parking spaces throughout downtown South <br />Bend for the Department of Comm u n4yjqyestment.. <br />[:] Required Contractor's Certification Forms, Attached (Non - <br />Collusion, Non-Doscrumination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of H Increase $ <br />0 Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />0 <br />F-1 <br />F-1 <br />El <br />El <br />El <br />