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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/23/2020 <br />Name Alicia Czarnecki Department Engineering/Fire <br />BPW Date 12/17/2020 Phone Extension 5903 <br /> <br />Required Prior to Submittal to Board BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br /> <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 /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name TBD <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 City of South Bend Wayfinding Signage Program – Phase 2 <br />Project Number 120-020 <br />Funding Source TIF <br />Account No. <br />324-10-102-121-442001—PROJ00000184/422-10-102-121-442001— <br />PROJ00000184/429--10-102-121-442001—PROJ00000184 <br />Amount <br />Terms of Contract <br />Purpose/Description Fabrication and installation of wayfinding signage at various locations in the <br />City. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br /> <br /> <br />Previous Amount <br />Current Percent of Change: <br />Increase <br />Decrease <br /> <br /> <br /> <br />New Amount <br />Total Percent of Change: <br />Increase <br />Decrease <br /> % <br /> <br /> <br />Time Extension Amount: <br />New Completion Date: <br />