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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 20, 2020 <br />Department Public <br />Name Scott <br />BPW Date October 27, 2020 Phone Extension 9245 <br />Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ Michael Schmidt <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. 4 ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Information <br />Company or Vendor Name Rieth-Riley Construction <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 />❑ Yes❑ If Yes, Approved by Purchasing <br />® No <br />❑ WBE Completed E-Verify Form Attached ❑❑ Yes <br />No <br />Bendix Dr., Lathrop to Indiana Toll Road <br />114-065 <br />LRSA - Streets & Alleys <br />251-06-600-506-442001 <br />4 days <br />Unit Price <br />Purpose/Description _Change Order No. 4 for the vacation of the 12 in existing gas main on <br />Bendix Dr. Additional 4 days to intermediate completion <br />date. <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: 4 days <br />New Intermediate Completion <br />Date: 9/27/2020 <br />