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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/30/2020 <br />Name Kieran Fahey Department Engineering <br />BPW Date 12/03/2020 Phone Extension 5993 <br /> <br />Required Prior to Submittal to Board Legal Attorney Name Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the Appropriate Item Type – Required for All Submissions <br /> Agreement Contract Proposal Addendum <br /> Professional Services Resolution <br /> Bid Opening Bid Award Req. to Advertise Title Sheet <br /> Quote Opening Quote Award <br /> Change Order No. C/O & PCA No. PCA <br /> Ease/Encroach. Traffic Control <br /> Other: Inter-local <br />agreement with Elkhart <br /> <br />Required Information <br />Company or Vendor Name: City of Elkhart <br /> <br />New Vendor Yes No If Yes, Approved by Purchasing <br />MBE/WBE Contractor MBE WBE <br />MBE/WBE Contractor Requested No Yes Name of Company <br />Project Name <br /> Resolution supporting biological monitoring of St. Joseph <br />river <br />Project Number NA <br />Funding Source Na <br />Account No. NA <br />Amount NA <br />Terms of Contract NA <br />Purpose/Description To assess the biological life of the St. Joseph <br /> Required Contractor’s Certification Form Attached (Non- <br />Collusion, Non-Discrimination, Non-Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <br />$ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br /> daragh.deegan@coei.org <br /> <br /> <br />