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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date:08/26/2020 <br />Department of Public Works –Engineering Division <br />Name:Finnian Cavanaugh <br />BPW Date: 09/08/2020 Phone Extension:5961 or fcavanau@southbendin.gov <br /> <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br /> <br />Purchasing <br />Check the Appropriate Item Type – Required for All Submissions <br />Professional Services Agreement Contract Proposal <br />Open Market ContractAmendment/AddendumSpecial 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: Ease./Encroach <br />Required Information <br />Company or Vendor Name TBD <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 NameTriumph Court Lighting Addition <br />Project Number 120-006E <br />Funding Source Light Up South Bend <br />Account No. 404-06-600-500-422018-06LUSB- <br />Amount TBD <br />Terms of ContractNTE <br />Purpose/DescriptionScope of work to include installation of four new streetlights on Burns Ave. <br />and Duey St. near Napoleon St. Work shall include extension of the existing <br />lighting circuit with new conduit and wiring. <br /> <br /> <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 /> <br />