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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/03/2020 <br />Name Alicia Czarnecki Department Engineering/Fire <br />BPW Date 09/22/2020 Phone Extension 5903 <br />Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <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 />n Other: n Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Information <br />Jones Petrie Rafinski Corrooration <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />E] MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />City of South Bend Wayfinding Signage <br />119-052 <br />TIF <br />422-10-102-121-442001PROJ000OO 184 <br />Amendment Amount: $5,425 ; New Agreement Amount: $24,525 <br />Design for sign locations and required concrete foundations for wayfinding <br />signage at various locations in the City. <br />For Change Orders Only <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Increase <br />Current Percent of Change: Decrease <br />New Amount <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />