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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June l l 2019 <br />Department Public <br />Name m...... m m Scott Kr eec^ Works <br />BPW Date June 25 2019 Phone Extension 9245 <br />mmrr�;nirrumwrnn�m�mvvvummuuuuuuuuuum � �erummnm�✓Mmn�uuurrr�vuuuuuwuu�uuuuurmrrr� um��vmrvmmm�: <br />,.,....._......... <br />BPWAttorney_..............�.._.... ..�,�.. ..,-.... ,,,,�,,,,,,,m..,..� -- . <br />_ _Required Prior to Submittal to Board <br />ITIT ITITIT mmmmIT _..._._ Attorney Name Clara McDaniel <br />Dept. Attorney E] Attorney Name <br />Purchasing Michael Schmidt <br />a Sere. <br />Professional Check I§e_ propriato Item Tie- R to <br />_..... <br />nal Services Agreement Contract <br />Ej Open Market Contract 0 Amendment/Addendum <br />j Bid Opening n Bid Award <br />❑ Quote Opening Quote Award <br />❑ Proposal Opening ❑ C/O & PCA No. <br />® Chg. Order, No. 1 E] Traffic Control <br />Other: <br />R-shred Information <br />All Submissions <br />Proposal <br />El Special Purchase, QPA <br />Req. to Advertise <br />E] Reject Bids/Quotes <br />PCA <br />Resolution <br />[❑ Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />Northern Indiana Construction <br />... .......................................................................�.��..�ww <br />Yes If Yes APurchasing <br />❑ ❑ Approved b Y Purchasing <br />New Vendor <br />No <br />❑ <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />MBE ❑ Nos <br />Project Name <br />East Bank....SSole Repairs <br />inkh., <br />..............rs ................................... <br />Project Number <br />l 18-305A <br />Funding Source <br />_ <br />Streets and Alleys <br />Account No. <br />226.0419.672.42.03 <br />Amount <br />$,728.��0�.�.�.�.�.�.........................................................................................................................................................�..............._w�w�w�w...w�w�..�www�w___- m,..................................�............ <br />687280 <br />Termsof Contract <br />.....�, <br />Base Quote�+.. Alternate �...2...................................................................................................................................................�._..�_... m. , <br />Purpose/Description <br />I` e ori,giral ALsign jp re ijjh ,ink hole was found to be insufficientITaftel <br />excavatinail further <br />investi gtiM .......... <br />For Chn!emmOrders On <br />Amount of Increase $ 14,482.75 <br />❑ Decrease ($ ) <br />Previous Amount $_ 68,728.00 <br />Increase .. ,....._..... 2 1....07.%.._.. <br />Current Percent of Change: Decrease ( % <br />New Amount $ 83,210.75 <br />Increase 21.07% <br />Total Percent of Change: Decreasemm mmmmmmmm% <br />Time Extension Amount: <br />New Completion Date: <br />