Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 20 2019 <br />Department <br />Name ��..._...............Jacob M. Klosinski......_��..��......_._..........�............._�����._._���._ <br />En ineer ink / Utilities <br />BPW Date August 27 2019 Phone Extension Ext. 9496 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br />Purchasing Z <br />Michael Schmidt <br />Checkthe A p 'rori to Item T ' � � , � All Submissions <br />.. .._-........ ._..... <br />® Professional Services Agreement Contract Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />Bid Opening <br />0Bid Award ❑I Req. to Advertise ❑ Title Sheel <br />Quote Opening <br />E Quote Award ❑ Reject Bids/Quotes <br />E] Proposal Opening <br />C/O & PCA No. PCA <br />E] Chg. Order, No. <br />Traffic Control [ Resolution <br />Other: <br />❑ Ease./Encroach <br />._. <br />R tired Informatmmion <br />Company or Vendor Name <br />American <br />SIftruc(ureoint, Inc (Indianapolis, <br />New Vendor <br />Yes, Approved by Purchasing <br />® No <br />MBEIWBE Contractor <br />Completed E-Verify Form Attached ❑ Nos <br />MBE <br />Project Name <br />f ppy Road / US 20 Lift Station Force Main Repair <br />Project Number <br />119-073 <br />Funding Source <br />Utilities Sewage Works O)erat�ons, Contractual Services —Other (TBD <br />Account No. <br />641-0630-793-63-35 (TBD) <br />� .�.,�aA._._..... <br />Amount <br />$41,200 <br />Terms of Contract <br />............... �............... ......_._ m..m. �. <br />Lump Sum (Task List Not to Exceed) <br />Purpose/Description <br />The Division of Engineering and Division ofl.Jtilitie j:eA.gq,g..thy; board of <br />Public Works a roval of a Professional Services A Bement with America <br />Structure oint Inc. for en ineeringbidding and construction services to <br />provide plans andspecifications for the Poppy Road / US 20 Lift Station <br />Force Mann renair oroiect. Refer to Metnoranduni and .At-yreement for detail <br />Amount of <br />Previous Amount <br />j Increase <br />Decrease <br />Current Percent of Change: <br />New Amount <br />Increase <br />Decrease <br />Increase % <br />Total Percent of Change: Decrease wmmm(mm ,m ,m% <br />Time Extension Amount: <br />New Completion Date: <br />