Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date SeL)te ber 3, 201.9 <br />Name Kara Boyles Department Engineering <br />BPW Date September lit 2019 Phone Extension 5933 <br />�����m�mmmmmmmmmH�Amm 555 <br />... ..... ............... <br />Rey Prior to Submittal to Board <br />�.. �.............. <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing 1:1 <br />Check the A <br />E] Professional Services Agreement <br />❑ Open Market Contract <br />❑ Bid Opening <br />E] Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />Other: Agreement <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 />,te Item .T p .._..:. <br />Contract <br />E] Amendment/Addendum <br />Bid Award <br />Quote Award <br />C/O & PCA No. <br />E] Traffic Control <br />Information <br />All Submissions <br />Proposal <br />LJ Special Purchase, QPA <br />n Req. to Advertise <br />(] Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Dave me r. Frame r <br />_........ Yes[:] ...... ____ ., . �................. ., �......_ <br />E] If Yes, Approved by Purchasing <br />No <br />❑ MBE Completed E-Verify Form Attached Yes <br />❑ WBE No <br />Jackson Road Sanitary Sewer Extension <br />119-072 <br />Sewer Contractual <br />641.0621.792.63.35 <br />$27.a,.,.,. <br />900 —paid to City by Dave Frame <br />Agreement between Mr. Dave Frame and the City of South Bend for <br />Reimbursement for the portion of the Sewer Extension that serves his <br />property. <br />�_........_ <br />F r Chan e Orders Only mm ....... ......... <br />Amount of � <br />r ease $ <br />� <br />De <br />Decrease <br />Previous Amount <br />........, <br />$ <br />w.w.........................................................................................................................._.......... <br />. <br />Increase......................�.�.�.�.�.�.�.........�ww.w� <br />. <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ _ ...................�...........................................�.........%�.................................�. <br />Increase.m�.. <br />� ��.�..............................................a� <br />_..._ m.... <br />Total Percent of Change: <br />Decrease <br />%) <br />Time Extension Amount: <br />New Completion Date: <br />