Supplement No 1 to Local Public Agency Project Coordination Contract - INDOT - Bendix Drive

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date June 4. 2019 Name Ro er Nawrot Department Public Works BPW Date June 11,2019 Phone Extension 5932 �nrmm, , uwiw ��muuuuumu�mm�m�mwusw mm�ww.�oimumara.... � n u�wuwimmm... mmmmmuum � ��,�;.. Required Su wired Prior to -� .. ....._.. _... ...... -... ... Submittal to Board g Attorney Name Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc greater than one year in length per the City Purchasing Policy Purchasing ❑ UnecK the LJ Agreement �] Professional Services Bid Opening Quote Opening Change Order No. El Ease/Encroach. FA Other: Amendm nt 01 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 Purpose/Description Eate Item �e 'e. , Contract El Resolution El Bid Award El Quote Award ❑ C/O & PCA No, 0 Traffic Control for All Prop sabmissons -.. �-Addendum ❑ Req. to Advertise ❑ Title Sheet ❑ PCA Required Information Department of Transportation ❑ No If Ye�roved bPurchasin Indiana M B ._.... .. .. es E:] WBE an Bendix❑ _ No Y e es Name of Com Drive 114._.�.��....._ _ �.�........� _...........�......... ..m..�......... ....� m�............ � _�........_ .._...... �...... $0.00 No Chan e in Contract Amount Time Extension for Construction Period, This document must be signed in blue ink. ] Required Contractor's Certification Form Attached (Non- C9119sion, Non -Discrimination, Non-DebarmenttEVify„ Iran, etc. Amount of ❑ Increase ❑ Decrease Previous Amount $ Current Percent of Change. New Amount $ Total Percent of Change: Copy Original ❑ ❑