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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 28 2019 <br />Department Public <br />Name......................................Scott Kree2er _ Works _ �..._Y—v.......................... <br />BPW Date JuIX 9 2019.Phone Extension 9245 <br />im�mimi ,.... � � nw m�uoimimimimm�mwmmuuwxn <br />rvnuuuuuuuuxuxuxuximimuuuuuuuuuuumw�wuen�m+nri <br />gcci�rd Prior to Submittal to Board <br />_...._............._ _ . �.. <br />BPW Attorney ❑ Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ Michael Schmidt <br />Check theITApp�~o_p,ate Item hype mm 1.�iw <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract 0 Amendment/Addendum <br />[❑ Bid Opening ❑ Bid Award <br />Ej Quote Opening Quote Award <br />Proposal Opening C/O & PCA No. <br />Chg. Order, No. 1 E] Traffic Control <br />Other: <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 />Information <br />All Submissions <br />LJ Proposal <br />E] Special Purchase, QPA <br />F'' Req. to Advertise <br />Reject Bids/Quotes <br />[❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />[� Michiana <br />tt:.w ro'Inc, <br />Yes :.........................__wm_. <br />�] If Yes, A <br />pproved by Purc�hasing . . <br />No <br />❑ MBE Completed E-Verify Form Attached <br />❑ WBE <br />VPA e estroom R modelin <br />118-043R <br />471-1138-452.42-.0.1..................m.......�....._ _....... �.........�.............._ <br />-_.�.........................................m�........._ <br />Parks Bond I <br />m........... <br />................................... <br />$490,000 <br />❑ Title Sheet <br />1:], Yes <br />No <br />Amount of z Increase 35,250.82 <br />Decrease <br />Previous Amount $ 490„000 <br />.Increase 7.19% .................�.m....�...._. _...... m...........................ww <br />g.........._�_.............. ......�.__.m...............................................m.... <br />Current Percent of Chan e: Decrease /o <br />_._..............�.m..m........... ................................. _ — <br />New Amount $ 525,250.82 <br />.. ..Increase. -- _..e ...N.. <br />..19% <br />�w..... ................... <br />Total Percent of Change: Decrease .._.... %) <br />Time Extension Amount: <br />New Completion Date: <br />