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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 17 2019 <br />�. <br />Name Kara Bo les Department Engineer <br />BPW Date December 19 2019 Phone Extension 5933 <br />....... ._....._................... .... -.... <br />Required Prior to Submittal to Board <br />._. _................ .................... _..... _._............. <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney El Attorney Name <br />Purchasing El <br />Check the A pro ate Item Ty <br />Professional Services Agreement n Contract <br />❑ Open Market Contract ® Amendment/Addendum <br />❑ Bid Opening Bid Award <br />Quote Opening Quote Award <br />❑ Proposal Opening C/O & PCA No. <br />❑ Chg. Order, No. ❑, Traffic Control <br />F-1 Other: <br />Reau red Information <br />All Submissions <br />Proposal <br />El Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Shee <br />Company or Vendor Name <br />St Joseph County <br />[� Yes El If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE/WBE Contractor <br />MBE Completed E-Verify Form Attached ❑� Nos <br />Project Name <br />Second Amendment to MOU for Portage Avenue Bridge Replacement <br />..................._W....... <br />Project Number <br />17JO25 <br />Funding Source <br />RWDA TIF/LRSA <br />Account No. <br />... ............_................w �._.........._ <br />324-1050-460.42-03 / 251-0608-431.42-96 <br />Amount <br />....................................... .............____.......... _ .. ....a. <br />Total $6846.80 (Increase of $892.65 for final closeout items) <br />Terms of Contract <br />mm-- .2, <br />Payment will be made once approved by BPW ........ <br />Purpose/Description <br />City's cost adjustment related to requested elements of work as part of the <br />County's project to replace the Portage Avenue Bridge. <br />-� <br />For Change Orders Only- <br />Amount of <br />Increase $ <br />0 <br />Decrease ($ ) <br />Previous Amount <br />$ <br />......... .........�.�......,....... �__........................... <br />Increase % <br />Current Percent of Change: <br />Decrease (o)mmmm mmmm <br />New Amount <br />. $ <br />_ <br />Increase ..,.�...................%wwww� ���� ..._................a <br />Total Percent of Change: <br />........................W <br />Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />........_ ......_ ......-........ .. �................. �..�. <br />