Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/11/19 <br />..e .. <br />Name Alicia Czarnecki/Roger Na��wv� t Department 1�"��ir�ccri�� <br />.....__ <br />BPW Date 1 /19/19 <br />.._. . ...... _, _...._. <br />Phone Extension 5903 <br />HE <br />R, ,qy rc d Prior to Submittal to Board <br />BPW Attorney <br />Attorney Name <br />Dept. Attorney <br />Attorney Name <br />Purchasing <br />........ __ <br />❑ <br />Check thed�daro riat 1teni Type — Required or All Submissions <br />_ — <br />Professional Services Agreement <br />Contract <br />Proposal <br />El <br />Open Market Contract <br />E] Amendment/Addendum ❑ Special Purchase, QPA <br />E <br />Bid Opening <br />❑ Bid Award ❑ <br />Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />® Quote Award Reject Bids/Quotes <br />F� <br />Proposal Opening <br />EJ C/O & PCA No. <br />E! <br />PCA <br />Chg. Order, No. <br />F-1 Traffic Control <br />F] <br />Resolution <br />Other: <br />E] <br />Ease./Encroach <br />le stared Information <br />Company or Vendor Name <br />TBD <br />New Vendor <br />Yes If Yes, Approved by Purchasing <br />® No <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached EJ <br />No <br />Project Name <br />2020 Signal Knock Downes& Wiring Investigation ITmmmmm <br />Project Number <br />119-110 _...._._ —. <br />Funding Source <br />Street Repairs and Maintenance <br />Account No. <br />_ 251-0608 431-36-10 <br />Amount <br />_.._ ........ <br />TB D <br />Terms of Contract <br />NTE <br />Purpose/Description <br />.. <br />Installation of traffic signal knock down re lac- <br />p ements and wiring <br />investigation at various locations within the City of South 'Bend, IN.. <br />For Chate -�c Orders f pdy <br />Amount of ❑ <br />[� <br />Increase $ <br />Decrease ($ ) <br />Previous Amount <br />Increase <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />.._ . ............ <br />$ _.. <br />o ._.._ _..m__........... u <br />Increase /° <br />Total Percent of Change: <br />Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />