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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 12019 <br />.__............. ....... <br />Department Public <br />Name Scott Kreeger Works <br />......... <br />BPW Date Aril 912019 Phone Extension 9245 <br />Mm M <br />RNuired Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDanlels <br />Dept. Attorney Attorney Name <br />Purchasing ® Michael. Schmidt <br />Check the Appro rat Item `l" o �- Re u <br />❑ Professional Services Agreement Z Contract <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening ❑ Bid Award <br />Quote Opening F� Quote Award <br />Proposal Opening C/O & PCA No. <br />El Chg. Order, No. ❑ Traffic Control <br />7 Other: Pronosal Award <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />(I or All Submissions <br />❑ Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />0 PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />.Slirewsberry & Associates, LLC <br />..... _ _ <br />Yes If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached F]Yes <br />WBE [:] No <br />School Zone Flashing Beacon Assemblies <br />117-075 R <br />_._.__ _._..................... <br />..... ....... <br />Professional Services / Other Professional Services <br />412-0602-431.31-06 <br />$79,372.00 <br />.M.... - ............. <br />Hourly NTE <br />Engineering design for the review and installation of school zone <br />flashing beacons within the City of South Bend. <br />For, 4-0g C3idexs <br />Amount of ❑ <br />Increase _......_.$ ....... <br />......... _._...__. -_._._ <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />_ <br />Increase <br />................._... ................ <br />% <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ ............. <br />. ... _.......... <br />Increase <br />uuu_ <br />% <br />�.._........ <br />Total Percent of Change: <br />Decrease <br />......... .... <br />%._.. <br />Time Extension Amount: <br />_........_ <br />New Completion Date: <br />