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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date9/14/20 <br />Department <br />NameKyle SilveusEngineering <br />BPW Date9/22/20Phone Extension9083 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />Officer Name <br />and Inclusion Officer <br />BPWAttorneyAttorney NameClara McDaniels <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 AwardReject Bids/Quotes <br />Proposal OpeningC/O & PCA No. PCA <br />Chg. Order, No. Traffic ControlResolution <br />Other: Ease./Encroach <br />Required Information <br />Company or Vendor NameJohn Boettcher Sewer & ExcavatingContractor, Ltd. <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 Name1201Western Ave. Sidewalk Vault Repair <br />Project Number 120-019 <br />Funding SourceOther Contractual <br />Account No.620-06-604-606-439001 <br />Amount$91,594.04 <br />Terms of Contract <br />Purpose/DescriptionAn unused under-sidewalk utility vault located at 1201 Western Avenue was <br />found to be in need of repair. The City of South Bend desires to partially <br />demolish and fill in this vault. The vault adjoins the basement wall of the <br />privately owned structure at 1201 Western Avenue. <br />For Change Orders Only <br />$ <br />Increase <br />Amount of <br />Decrease($) <br />Previous Amount$ <br />% <br />Increase <br />Decrease(%) <br />Current Percent of Change: <br />New Amount$ <br />% <br />Increase <br />Decrease(%) <br />Total Percent of Change: <br />Time ExtensionAmount: <br />New Completion Date: <br /> <br />