Project Coordination Contract - INDOT - School Zone Flashing Beacon Assemblies Project

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date December 21, 2018 Name Scott Kree ..__ ger Department Public Works Division/Bureau Engineering BPW Date January 8, 2019 Phone Extension 9245 .._ ... w..._a ---- .. .._ .. Required Prior to Submittal to Board Legal Z Attorney Name: Clara McDaniels Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ❑, Michael Schmidt _Check the Agreement Amendment Professional Services [] Bid Opening ❑ Quote Opening Change Order No. Ease/Encroach. F1 Other: rrote Item Te_ - Contract El Resolution ❑ Bid Award ❑ Quote Award F] C/O &PCANo. Traffic Control: Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Reaugired Information for All Submissions I Proposal Req. to Advertise PCA Yes U No U If Yes,_AProved by__ Purchasin No E_ YesBName of...C.orl�.......�y School Zone Flashing Beacon As semblies 117-075 Addendum ❑ Title Sheet Purpose/Description Project coordination contract between the City of South Bend and INDOT specifically regarding the School Zone Flashing Beacon ro ectIT El Required � Contractor's Certification Forms Attac hed (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) e�uird For Change Orders Only Amount of ❑ Increase $ ❑ Decrease $ Previous Amount $ Current Percent of Change: /° New Amount $ __.._Chang:w Total Percent of Dispersal After Aogroval-.....�......�..........��._�wm��.� ...........�........_..ww �.... Copy Original ❑ ❑