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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/10/19 Department Public Works <br />Name Kyle Silveus..�.�.�........._,,,,, �............................-..�...�.�.�...�.�.�.._.�._.._�........�..._ .�..._....____.... <br />Division/Bureau Engineering <br />BPW Date 9/24/2019 Phone Extension 9083 <br />N <br />_Be uired Prior to Submittal to Board <br />Legal ® Attorney Name: Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ Michael Schmidt <br />Check the AMRpriate Item Type — Required for All Submissions <br />g � 0 Proposal M Addendum <br />Agreement Contract <br />[� Professional Services [:] Resolution <br />Bid Opening E] Bid Award Req. to Advertise ❑ Title Sheet <br />j Quote Opening El Quote Award <br />Change Order No. 1 0 C/O & PCA No. ❑ PCA <br />F] Ease/Encroach. ❑ Traffic Control: <br />El Other: <br />Roquired Information <br />Company or Vendor Name <br />Indiana Dewrtment of Transportation <br />New Vendor <br />❑Yes H No If Yes,wA�a rove Purchasing _... <br />MBE/WBE Contractor <br />❑ MBE W B E <br />MBE/WBE Contractor Requested <br />❑ No [] YesNameoCom an <br />�r <br />Safe Routes to School near LaSalle Intermediate and Marquette <br />Project Name <br />Primary <br />Project Number <br />ENG: 116-040 DES No: 1600076 <br />Funding Source <br />LOIT Ma'ot r Projects <br />Account No. <br />257.0608.431.42.96 <br />Amount <br />$1,589,000 <br />Terms of Contract <br />.�........... ...... ............... � �6 - - <br />80% Federal- 20% Local <br />Purpose/Description <br />This change order is a time extension of 6 days only due to utility <br />delays by AEP. When this change order is approved, it is to be <br />sent to Scott Randle at American Structurepoint at <br />srandlestructurepoint.com <br />Disoersal After <br />Copy <br />Original <br />® <br />❑ Kyle Silveus <br />aitlin Stevens, MACOG <br />❑ <br />❑ <br />