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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 Division/Bureau Engineering <br />BPW Date 9/24/2019 Phone Extension 9083 <br />rnum'udu'r,�rr�. �'�r' '.�nuimrnx, muomuioi.m ..... muuuuuuuuuuuuumwuuuuvirvunm�u.... u,N r� <br />_� N� hired Prior to "Submittal to Board_ m _� <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 />H Agreement <br />Professional Services <br />Bid Opening <br />❑ Quote Opening <br />® Change Order No. 1 <br />Ease/Encroach. <br />Other: <br />LJ Contract <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />E' C/O & PCA No. <br />E Traffic Control: <br />Proposal <br />Addendum <br />Company or Vendor Name <br />Indiana Department of Transportation <br />New Vendor <br />[ Yes Noo ifYes, Aved by Purchasing <br />MBE/WBE Contractor <br />MBE^m�mmm <br />/W <br />MBEBE Contractor Requested � an <br />s l� '� <br />q No ❑Ye. Nameof Com.,�..near <br />Safe Routes to School arquette <br />LaSalle Intermediate and M <br />Project Name <br />Prima <br />Project Number <br />ENG: 116-040 DES No: 1600076 <br />FundingSource <br />LOIT Mafor .... _.���_ _w ....�...._...���� _..._�.���.�......._. <br />,_m Protects <br />Account No. <br />257.0608.431.42.96�............. <br />Amount <br />.....� ....... ..... <br />$1,589,000 m.����.�.� ..�w ....... .... <br />Terms of Contract <br />�0�/ 20% Local <br />Purpose/Description <br />This change olyder s 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 />srandle@structurepoint.com <br />L Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />„�, �'� <br />Amount of _._,, <br />Increase $ 6 Additionals <br />Da <br />E] Decrease <br />$ <br />Previous Amount <br />.... <br />��_...��... .....-. ...._�............... . ..... <br />1,89,000 <br />Current Percent of Change: <br />�..... <br />0 <br />New Amount <br />$ $1,589,000�.. <br />Total Percent of Change: <br />o.�.........ww ..,,.... m...... <br />0 /o <br />Dispersal After <br />Copy <br />Original <br />® <br />Kyle Silveus <br />® <br />El Caitlin Stevens MAC OG <br />