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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />12/16/19 <br />Silveus <br />Department Engineering <br />BPW Date 12/19/19 Phone Extension 9083 <br />WHORequired 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 anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Michael Schmidt <br />Check the <br />Agreement <br />Professional Services <br />Bid Opening <br />[❑ Quote Opening <br />❑ Change Order No, <br />Ease/Encroach. <br />1G Other: <br />aropriate Item Type <br />El Contract <br />❑ Resolution <br />❑ Bid Award <br />El Quote Award <br />❑C/O &PCANo. <br />_ <br />Traffic Control <br />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />Information <br />❑ PCA <br />Company or Vendor Name SBCC Development Corporation <br />New Vendor ❑ Yes No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name South Bend Chocolate Factory and Museum <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ <br />DP18-046 <br />River West Development Area <br />Addendum <br />❑ Title Sheet <br />324-10!*046-4204 <br />$446,148.00_....__....................................._w...�w_www ._.......................w�� <br />.. w.................. <br />Agreement for theextensionof public water and sewer main <br />Outlines requirements for the construction of oublic water and sewer <br />U Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment, E-Verifv. Iran. etc. <br />Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: _..._. <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />0 <br />El <br />