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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /5/19 Department Public Works <br />..................... _............. _.............. <br />Name Kyle Silveus Division/Bureau Engineering <br />.........................__ �..._............... <br />......... <br />BPW Date 11 /12/19 Phone Extension 9083 <br />uired 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 <br />H Agreement <br />[] Professional Services <br />Bid Opening <br />❑ Quote Opening <br />® Change Order No. 2 <br />Ease/Encroach. <br />F Other: <br />n Michael Schmidt <br />LJ Contract <br />E] Resolution <br />F] Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ 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 />Indiana Earth, Inc. <br />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />Yes LJ No LJ If Yes, Approved by Purchasi <br />MBE ❑ WBE <br />�................W <br />No F1 Yes Name of Comoanv <br />Western Ave. Streetsca e -,_Phase III <br />............. ......................... <br />118-076 <br />_.................... ............................. <br />RWDA TIF....-....... _....... <br />324-1050-460-42-03 <br />$133, 724.31 <br />Addendum <br />❑ Title Sheet <br />Additional work needed due to unforeseen conditions including <br />utility conflicts <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />ii/ ri -, / ri r, .,r/i //,r ,ri / i r / r�. //..,, ., / ,,.. /... ,,, ,:, rir//. Jr/ i „ ..✓ ,r, i„ r r r..,,. <br />/r <br />„/ <br />Amount of ® Increase $ 133,724 31 <br />❑ Decrease � -----__ _................N. __.... <br />Previous Amount $ 2,675,816.35 <br />.........._................................................. .-_..-...................... <br />Current Percent of Change; 5% ._........ <br />New Amount $ 2,809,540.66 <br />Total Percent of Change: 6.65%._m............. _................._....... <br />Disoersal After <br />Copy <br />Original <br />n <br />❑ <br />n <br />F <br />❑ <br />❑ <br />