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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/22/2020 <br />Department VPA <br />Name Patrick Sherman <br />BPW Date 04/28/2020 Phone Extension 5601 <br /> <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Clara McDaniels <br /> <br />Purchasing Michael Schmidt <br />Check the Appropriate Item Type – Required for All Submissions <br />Professional Services Agreement Contract Proposal <br />Open Market Contract Amendment/Addendum Special Purchase, QPA <br />Bid Opening Bid Award Req. to Advertise Title Sheet <br />Quote Opening Quote Award Reject Bids/Quotes <br />Proposal OpeningC/O & PCA No. PCA <br />Chg. Order, No. Traffic Control Resolution <br />Other: Notice of Intent to do Ease./Encroach <br />work with own workforce <br />Required Information <br />Company or Vendor Name VPA internal workforce <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE Yes <br />MBE/WBE Contractor Completed E-Verify Form Attached <br />WBE No <br />Project NameMuessel Grove Public Restroom <br />Project Number 118-099 <br />Funding Source Park Bond Series I, TIF Park Bond <br />Account No. 471-1137-452.42-01, 452-1101-452.42-01 <br />Amount Approximately $160,000 <br />Terms of ContractN/A <br />Purpose/Description_Memo to the Board to request approval to perform a public work with the <br />City’s own workforce pursuant to Indiana Code 36-1-12-3 <br />For Change Orders Only <br />$ <br /> Increase <br />Amount of <br /> Decrease ($ ) <br />Previous Amount$ <br />% <br />Increase <br />Decrease ( %) <br />Current Percent of Change: <br /> <br />New Amount $ <br />% <br />Increase <br />Decrease ( %) <br />Total Percent of Change: <br /> <br />Time Extension Amount: <br />New Completion Date: <br /> <br />