Agreement - Local Roads & Bridges Matching Grant - 2019 Community Crossings Round 2 - INDOT

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date October 30 2019 Name Scott Department Public Works BPW Date November 12 2019 Phone Extension 9245 wmmi mmmmmu�uuuuuummuuuuuuumuwiuwiuiuiuuuuuuuum�m�uummuiuiuwiuwiuwiuwimmmuiuim ;idm�,m Required Prior to Submittal to Board BPW Attorney Attorney Name Clara McDaniels Dept. Attorney ❑' Attorney Name Purchasing ❑ Michael Schmidt Check the A Professional Services Agreement Open Market Contract F Bid Opening ❑ Quote Opening ❑ Proposal Opening Chg. Order, No. _ Other: ate Item T t: Contract ❑ Amendment/Addendum ❑ Bid Award 0 Quote Award ❑ C/O & PCA No. ❑ Traffic Control R Nt i d Information All Submissions ❑ Proposal 0 Special Purchase, QPA E] Req. to Advertise F-1 Reject Bids/Quotes ❑ PCA Resolution Ease./Encroach ❑ Title Sheet Company or Vendor Name INDOT .�.® New Vendor Yes l..IfYes, ...ApprovedEl by Purchasing No MBE/WBE Contractor ❑ WBE Completed E-Verify Form Attached ❑ Nos Project Name 2019 Community Crossings Round 2 Project Number 119-065 ____________.._.-e....s, ,....m. ......_. �........ ...... ww_ Funding Source LRSA _ AccountNo. 251-0608-431...3...1.._.06..............�...._.._.._.._............�........�,,,,,,.�,,,�.............�.�......�.�....._.....��_.... �......._._._._._........._.._ .......... Amount $367„634.16 Terms of Contract Purpose/Description Pi ect coordination contract between the City of South Bend and INDOT SpK6fically regardin the 2019 Community Crossin Matching Grant For Chs,h e Order�y.........�.mm.... �...._ ❑ Increase $ Amount of .......... _......... ........ ❑ Decrease ($ ) Previous Amount Current Percent of Change - New Amount Total Percent of Change: Time Extension Amount: New Completion Date: Increase Decrease (....................% Increase % Decrease ..._.(�..._....w�