Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/18/2019 �.. �,� <br />, ....... �� �� . _................... <br />Department Public <br />Name Zach Hurst <br />Works <br />BPW Date 06/25/2019 <br />Phone Extension 3057 <br />_.._.. <br />..........._..............� ............ <br />l . tuired Prior Submittal to Board <br />BPW Attorney ® <br />Attorney Name Clara McDaniels..... <br />Dept. Attorney <br />Attorney Name <br />Purchasing ❑] <br />_._._........._............._........_�_�.�.� �_................................................... .....�..................................... ww.....�w----- <br />f......_............_.._.._._._.............._._.....-Check the � tot riate Item...I ` rr c + t> All Submissions <br />. .w _�� <br />Professional Services Agreement ❑Contract <br />[� <br />............. <br />Proposal <br />Open Market Contract <br />❑ Amendment/Addendum <br />Special Purchase, QPA <br />0 Bid Opening <br />❑ Bid Award <br />Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />Reject Bids/Quotes <br />Proposal Opening <br />❑ C/O & PCA No. <br />E:1 <br />PCA <br />Chg. Order, No. <br />❑ Traffic Control <br />F-� <br />Resolution <br />Other: Interlocal A Tccn c t <br />0 <br />Ease./Encroach <br />...... __.._.. <br />_..._._._._........_ .%1 Ruired Information <br />Company or Vendor Name <br />INDOT — LaPorte District <br />�.wwwu.w._ww <br />❑ <br />Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached ❑ No <br />Project Name <br />Cleveland Rd./Br ianmm.......... <br />/ k . Rd. P„avem„ent...Im„�rovements..................................................w.. <br />Project Number <br />119-045 <br />Funding Source <br />RWDA TIF <br />Account No. <br />324-1050-460-42.03 <br />Amount <br />$1,677,300.00 <br />Terms of Contract <br />........... <br />.....a..................................................................................................... <br />Memorandum of Underst .......1.........b.et ..-...w teen..ocalmmand.state..�°�............. <br />n g <br />Purpose/Description <br />�. <br />. .._.............. <br />OU between Cit and 1NDOT for local Pavement replacement during�aW sty <br />construction® Droi ect. <br />__._....._.. ..... ..- ..... _.... _.. ............._.._........._ ._. <br />For Change Orders Only <br />Amount of Increase $ mmmmmmmm —____ <br />Decrease ($ <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />% <br />New Amount <br />$ <br />_ <br />Increasemmm� <br />% <br />Total Percent of Change: <br />Decrease <br />( % <br />Time Extension Amount: <br />New Completion Date: <br />