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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date07/21/2020 <br />DepartmentDPW <br />NameZach Hurst <br />BPW Date07/28/2020Phone Extension3057 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />Officer Name <br />and Inclusion Officer <br />BPWAttorneyAttorney Name <br />Dept. AttorneyAttorney Name <br />Purchasing <br />Check the Appropriate Item Type –Required for All Submissions <br />Professional Services AgreementContractProposal <br />Open Market ContractAmendment/Addendum Special Purchase, QPA <br />Bid OpeningBid AwardReq. to AdvertiseTitle Sheet <br />Quote OpeningQuote Award Reject Bids/Quotes <br />Proposal OpeningC/O & PCA No. PCA <br />Chg. Order, No. 3Traffic ControlResolution <br />Other: Ease./Encroach <br />Required Information <br />Company or Vendor NameIndiana Earth, Inc. <br />YesIf Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBEYes <br />MBE/WBE ContractorCompleted E-Verify Form Attached <br />WBE No <br />Project Name320 at the Cascade –Site Utilities <br />Project Number 118-074D <br />Funding SourceRiver East TIF <br />Account No.429-10-102-121-442001 <br />Amount$6,039.50 <br />Terms of Contract <br />Purpose/DescriptionChange order covering unforeseen conditions –contaminated soil. <br />For Change Orders Only <br />$6,039.50 <br />Increase <br />Amount of <br />Decrease($) <br />Previous Amount$189,183.00 <br />3.19% <br />Increase <br />Decrease(%) <br />Current Percent of Change: <br />New Amount$195,222.50 <br />15.88% <br />Increase <br />Decrease(%) <br />Total Percent of Change: <br />Time ExtensionAmount: <br />New Completion Date: <br /> <br />