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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br /> <br />Date 10/15/2020 <br />Name Leslie Biek Department PW <br />BPW Date 10/27/2020 Phone Extension <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br /> <br />Purchasing Ron O’Connor <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 <br />Sheet <br /> Quote Opening Quote Award Reject Bids/Quotes <br /> Proposal Opening C/O & PCA No. PCA <br /> Chg. Order, No. 4 & 5 Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name INDOT- (Rieth Riley Contractor) <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor MBE <br /> WBE Completed E-Verify Form Attached Yes <br /> No <br />Project Name Corby Ironwood Rockne Intersection Improvement <br />Project Number 116-034 <br />Funding Source LR&S Streets and Alleys <br />Account No. 442001 <br />Amount $13,920.77 <br />Terms of Contract Unit Price <br />Purpose/Description CO #4 is for an additional $1,592.85 to change the signal head visor on <br />Rockne after it was installed and to remove the banner arms from the <br />streetlights after instillation. CO#5 is for an additional $12,327.92 to <br />repair irrigation lines that were damaged during construction. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ 13,920.77 <br />($ ) <br />Previous Amount $ 3,162,661.70 <br />Current Percent of Change: <br />Increase <br />Decrease <br />0.44% <br />( %) <br /> <br />New Amount $ 3,176,582.47 <br />Total Percent of Change: <br />Increase <br />Decrease <br />1.30% <br />( %) <br /> Time Extension Amount: <br />New Completion Date: