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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/11/19 <br />Name Alicia Czarnecki Department Engineering <br />---------------- <br />BPW Date 12/19/19 Phone Extension 5903 <br />BPW Attorney <br />RgL�ir d Prior to Submittal to Board <br />Attorney Name <br />Dept. Attorney F-1 Attorney Name <br />Purchasing <br />Check t ro JItem T c _ Rc; <br />Professional Services es A e ent <br />Contract <br />ontract <br />E] <br />Open Market Contract <br />Amendment/Addendum <br />Bid Opening <br />[ <br />Bid Award <br />Quote Opening <br />Quote Award <br />❑ <br />Proposal Opening <br />C/O & PCA No. <br />® <br />Chg. Order, No. 1 <br />[l <br />Traffic Control <br />F-1 Other: <br />Company or Vendor Name <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 />All Submissions <br />LJ Proposal <br />F Special Purchase, QPA <br />0 Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />[—] PCA <br />E] Resolution <br />Ease./Encroach <br />Ge Yes l. Flu Industries, <br />Yes <br />i, Inc <br />.__. <br />Approved by Purchasing <br />® No <br />MBE ❑ WBE Completed E-Verify Form Attached Nos <br />Citof South Bend Wayfinding Signa a Program - Phase 1 <br />119-052 R <br />....................................... <br />West Washington TIF ($10,000.00) <br />River East TIF ($30,000.00) <br />River West TIF ($25,700.00) <br />Professional Services (rest of amount) <br />324-1050-460-42-03 ($10,000.00) <br />429-1050-460-42-03 ($30,000.00) <br />422-1050-460-42-03 ($25,700.00) <br />217-0602-367-31-06 (rest of amount) <br />Purpose/Description CO #1 — Added Contract Time due to Decorative Pole Lead Time <br />For ChanLc Orders Oi l <br />Amount of Increase $ 0 <br />❑ Decrease ($ 0) ����..............................._..............�..___ <br />.............._................._.........-.......... <br />Previous Amount $ <br />.................................................... <br />Increase 0% <br />Current Percent of Change: Decrease (0%) <br />New Amount $- ................. <br />Increase % <br />_....................................... <br />Total Percent of Change: Decrease ( % <br />mm Time Extension Amount: 63 days ITITITITITITITITITITITITITITITITITITITm <br />New Completion Date: 1/24/2020 <br />