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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date09/14/2020 <br />DepartmentDPW <br />NameZach Hurst <br />BPW Date09/22/2020Phone Extension3057 <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. Attorney Attorney 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: LPA/Utility Ease./Encroach <br />Reimbursement Agreement <br />Required Information <br />Company or Vendor NameSt. Joseph Co. Board of Commissioners <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 NameDouglas Road Lift Station <br />Project Number 118-116 <br />Funding SourceDouglas Road DA TIF <br />Account No. <br />Amount$569,820 <br />Terms of ContractLump Sum <br />Purpose/DescriptionThis agreement stipulates the City pay 20% of the construction costs for the <br />Douglas Road Lift Station (and forcemain relocation) which will be included <br />in the County’s road project. <br />For Change Orders Only <br />$ <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 />