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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 14, 2019 Department Public Works <br />Name Scott Kreeger Division/Bureau Engineering <br />BPW Date January 22, 2019 Phone Extension 9245 . . . . ..... <br />=MwWMffl�fflJM 0WMff=ffMffgqyM�=HM1u <br />... . ...... . . . .. . .......... <br />L . .......... ,B9_qL!i'red Prior to Submittal to Board <br />Legal 0 Attorney Name: Clara McDaniels <br />Controller El 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 Michael Schmidt <br />Check the <br />Agreement Amendment <br />F-1 Professional Services <br />Fj Bid Opening <br />F-1 Quote Opening <br />El Change Order No. <br />E Ease/Encroach. <br />F-1 Other: <br />)ropriate Item jypt- Req <br />El Contract <br />El Resolution <br />M Bid Award <br />F-1 Quote Award <br />0 C/O & PCA No. <br />F-1 Traffic Control: <br />for All Submissions <br />f _F i �o_p"o" 's" a —I'- - " " — <br />El Req. to Advertise <br />uired Information <br />F-1 PCA <br />Addendum <br />El Title Sheet <br />Company or Vendor Name <br />Michiana Contract!r�, Inc. <br />New Vendor <br />Yes Z No . ... ... <br />El If Yes, Ap roved Purchasing <br />pE_!�q <br />MBE/WBE Contractor <br />1_.� <br />­-0.­ . ..... __ <br />MBE WBE <br />MBENVBE Contractor Requested <br />No Yes Name of C­om p -a---'---- _L_C_ — - -------- <br />py DA DoddL <br />Project Name <br />VPA Rest Remodelimmmm�wn <br />Project Number <br />118-043R <br />Funding Source <br />471- <br />Account No. <br />Parks Bond I <br />Amount <br />$490,000 <br />Terms of Contract <br />Base Bid + 5 Altee <br />ccessibiiiymen _—­,""-- <br />' <br />—Purpose/Description In <br />s t a I I a -i'r-ipr6vements—for­e—parks within the City <br />of South Bend <br />—..... <br />F� Required contractor's C'e—ri-if—ic a tio _ n Forms "'Attached —(Non- <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />.. ............. ... <br />. __­"_"_­uired For Change Orders Oni <br />Amount of ❑ increase <br />$ . ..... . <br />F] Decrease <br />$ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Chan <br />Mq�!After pp <br />�p r <br />Copy Original �A <br />F] Patrick Sherman, Project Manager <br />—K-a-'ra '"Boyles <br />