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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/14/19 Department Public Works <br />Name Kyle Silveus Division/Bureau Engineering <br />BPW Date 10/22/2019 Phone Extension 9083 <br />m �w. wu;wwwwr w +uw wuw.ommmmmrm.muArmromuoMON �i.... mn irrtrrmuv Aurvm000000mmmI�re ffav� <br />egired 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 <br />�j Agreement <br />Professional Services <br />E] Bid Opening <br />F-1 Quote Opening <br />® Change Order No. 2 <br />❑ Ease/Encroach. <br />�d Other: <br />)ro riate Item Type <br />Contract <br />E Resolution <br />Bid Award <br />El Quote Award <br />El C/O &PCANo, <br />F' Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />Required Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Indiana Department of Transportation <br />[ wMB W WWIf Yes, Ar) F9ved by <br />P -u----r----q <br />ha pq <br />______ ... aa... <br />No � .Yes Name of Com�an <br />Safe Routes to School near LaSalle Intermediate and Marquette <br />Primary <br />ENG: 116-040 DES No: 1600076 <br />LOIT Maior Projects mmm <br />257.0608.431.42.96 <br />$1, 589,000_— <br />_..... ....� .. � � �.�..... <br />80% Federal- 20% Local <br />.. _. f! _�..,.., ............... .. m.........�.. �...._..........................................- <br />This change order is a time extension of 36 days only due to <br />additional sidewalk repairs in the project. When this change <br />order is approved, it is to be sent to Scott Randle at American <br />Structurepoint at srandle@structurepoint.com <br />L Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />For Thai' a Ordewrs n <br />ired_.__ <br />Increase $ 36 Additional Dars� <br />Amount of m„� _....�— ,.. �� ....�. <br />Decrease $ <br />Previous Amount <br />g /° <br />Current Percent of Change., 0° �-�......��,.�.... ...�..... ���. �_�_.... ,�......_. _........�............... <br />New Amount $ $1,589,000 <br />Total Percent of ghan e mmmmmIT0% <br />..........__ <br />.......... .. A naval <br />Dispersal After <br />Copy Original <br />® Kyle Silveus <br />Caitlin Stevens, MACOG <br />