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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />01/28/2020 <br />Department Engineering <br />BPW Date 2/11/2020 Phone Extension 5920 <br />�._...._ ._ ... IT _,�,uired Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Villa <br />Dept. Attorney 11 Attorney Name <br />Purchasing <br />c heck the Ap o ?riat Item T rcel�c�rw i <br />El Professional Services Agreement Contract <br />Open Market Contract Amendment/Addendum <br />Bid Opening [ Bid Award <br />❑ Quote Opening Quote Award <br />❑ Proposal Opening ® C/O & PCA No. 1 final <br />❑ Chg. Order, No. ❑ Traffic Control <br />EJ.2t—her--..--. <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 />N! g§e/Descn�Li( <br />Amount of ❑ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Information <br />All Submissions <br />H Proposal <br />El Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />PCA <br />Resolution <br />Easew/Encroach <br />Michiana Contractin Inca <br />Yes If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached <br />WBE <br />Notre Dame Ave. APS <br />119-090 <br />....... ........ <br />.. <br />.....-._....�. _ <br />Traffic Si nal Maintenance <br />251.0608.431.36.67 <br />Prpiect Closeout <br />For ChanChann Orders <br />Increase $ <br />137 <br />Decrease .50 <br />$ 16,337.50 � WWWWWWWWW Increase % _ <br />Decrease (6.96%) <br />$ 15,200.00 <br />Increase % <br />(6.96% WW <br />Decrease .. ) <br />❑ Title Sheet <br />El Yes <br />No <br />