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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 21, 2020 <br />Department Public <br />Name Scott Kreeger Works <br />BPW Date July28, 2020 Phone Extension 9245 <br /> <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <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 Opening C/O & PCA No. PCA <br /> Chg. Order, No. Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name <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 Name 2020 Community Crossings Round 1 <br />Project Number 120-012 <br />Funding SourceLRSA <br />Account No. 251-0608-431.31-06 <br />Amount <br />Terms of Contract <br />Purpose/Description ____Milling & resurfacing of various roadways within the City of South <br />Bend._______________________ <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 ExtensionAmount: <br />New Completion Date: <br /> <br />