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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/05/20.19 <br />Department Public <br />Name Toy Villa <br />BPW Date 8/13/2019 Phone Extension 5920 <br />; immuwaurvw il�mmmmommmmmmnmmmmmmmmmmumummmmmummmmmmmmuuuuuuuuuuuu i mm�arwmmWwm w0000000000000o ivimmw.mwmmMEMO rmm� <br />RR <br />quir,Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney <br />Purchasing <br />Attorney Name <br />Check the Ammo rl <br />Item Type — l'iequired,l r All Submissions <br />H Professional Services Agreement II Contract <br />Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />[] Quote Opening <br />F-1 Quote Award <br />Proposal Opening <br />C/O & PCA No. <br />❑ Chg. Order, No. <br />❑ 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 />-,.qu fed Information <br />Proposal <br />Special Purchase, QPA <br />E] Req. to Advertise <br />0Reject Bids/Quotes <br />® PCA <br />❑ Resolution <br />Ease./Encroach <br />---- <br />❑ Title Sheet <br />Northern Indiana Construction <br />_..�... ........� ........ ............................. �........ <br />.. <br />Yes❑ If Yes, Approved by Purchasing <br />Z No <br />MBE Completed E-Verify Form Attached El Yes <br />❑] WBE [ No <br />East Bank Sinkhole Renairs <br />118-305A <br />Streets and Alleys <br />226.0419.672.42.03 <br />$83,210.75 <br />_Project Closeout <br />.......... <br />For w"hq� Orders <br />Increase $ <br />Amount of _ �, ............... <br />�]Decrease ($ ) <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease ( %) <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease ( %)mmmmm ... <br />Time Extension Amount: <br />New Completion Date: <br />