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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/30/2019 <br />Department Public <br />Name Scott Kreeger w Works <br />BPW Date 10/8/2019 Phone Extension 9245 <br />N <br />lCN!�ired Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney F-I Attorney Name <br />Purchasing Michael Schmidt <br />Check the A proms to Item TvDe -- <br />Professional Services Agreement ❑ Contract <br />FOpen Market Contract <br />0 Amendment/Addendum <br />❑ Bid Opening <br />El Bid Award <br />E] Quote Opening <br />Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />❑ Chg. Order, No. <br />Traffic Control <br />Other: Agreement <br />Information <br />Company or Vendor Name City of Mishawaka <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 />All Submissions <br />Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />17 PCA <br />Resolution <br />Ease./Encroach <br />Yeses If Yes, Approved by Purchasing <br />No <br />❑ Title Sheet <br />MBECompleted E-Verify Form Attached El Nos <br />2019 Community Crossin _ s� <br />.... ...._.__ <br />119-015 <br />Local Road and Bridge Grant <br />�._...._......__........_. .............. _............ ....................w .........._ <br />265-0608-431.36-10 <br />$904.00 <br />Cit a rroement for the stri i ol" IeflTM rsol B rr levard i�a Cit of Mishawal <br />t-of way <br />For Change ,Orders Only <br />Amount of Increase <br />❑� Decrease ($ � �...�....��...........__.. ..... �.� ........�...�.................. <br />Previous Amount $ <br />Increase % .................................. <br />Current Percent of Change; Decrease % <br />New Amount <br />Increase.....��.......................% <br />Total Percent of Change:. Decrease..........m% o <br />Time Extension Amount: <br />New Completion Date: <br />