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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/01/2019 �. _.... <br />Name Zach Hurst <br />Department Public <br />Works <br />BPW Date 10/08/2019 Phone Extension 3057 <br />i��mmmarrmnunmmm�'mmumimimuuuuuuummmmmmm�nmmm�m�m�m�mmmmmmum�m�mmmmmmuuuuuuumimimmmuummmmuummimimmm��uummimuuuuu�mumummmmmmmmmmmmmmmmwwmmmmm wmmmmnl'mmummmm�� <br />..... <br />Required Prior to Submittal to Board <br />vv�............... <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney El <br />Attorney Name <br />Purchasing❑ <br />�� <br />.......................�................................... .._� _�. <br />.. ....._.� ...__. .... __. _ ._._ ..__.._ _ _ ............ .._ . <br />Check the Appropriate Item � tlAll Submissions <br />Professional Services Agreement EJ Contract <br />[] Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award <br />Req. to Advertise ❑ Title Sheet <br />0 <br />Quote Opening <br />® Quote Award <br />❑ Reject Bids/Quotes <br />Proposal Opening] <br />C/O & PCA No, <br />❑ PCA <br />E] <br />Chg. Order, No. <br />Traffic Control <br />❑ Resolution <br />0 Other: <br />❑ <br />Ease./Encroach <br />e uired Information <br />Company or Vendor Name <br />Indiana Earth, Inc. <br />New Vendor <br />Yes If Yes, Approved by Purchasing <br />No <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached ❑ No <br />Project Name <br />Ivy Tech Pod Disposal <br />Project Number <br />119-091 <br />Funding Source <br />RWDA TI F <br />.........� _. <br />Account No. <br />324-1050-460-42.01 <br />Amount$..._....100.0 <br />..................................................................... <br />41 0 <br />............................... .....................ww....... <br />Terms of Contract <br />.. ........................... ._.......................ww wwww---------- <br />LumpSum...................... <br />�u�w�_._..........�....................................._�... � <br />mm._.. <br />Purpose/Description <br />Quote project to disas semble and remove pod classrooms from <br />Redevelopment Commission pai-eel on Michi lan Street. <br />For Change OrdersOnly <br />Amount of ❑ Increase $w <br />❑ Decrease ($ <br />_._..._..._....._......._.............................................. ......__ �_..............._ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Con Dletion Date: <br />Increase % <br />Decrease ( % <br />Increase % <br />Decrease m ( % <br />