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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 11, 2020 <br />Department <br />Name Jacob M. Klosinski EnOneerim/Utilities <br />BPW Date December 17, 2020 Phone Extension Ext. 9496 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer <br />❑ <br />Officer Name <br />Michael Patton <br />BPW Attorney <br />❑ <br />Attorney Name <br />Clara McDaniels <br />Dept. Attorney <br />❑ <br />Attorney Name <br />Clara McDaniels <br />Purchasing <br />❑ <br />Michael Schmidt <br />Check the Appropriate <br />Item Type <br />— Re uired or All Submissions <br />❑ Professional Services Agreement <br />❑ Contract <br />❑ Proposal <br />❑ Open Market Contract <br />® Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />❑ Resolution <br />❑ Other: <br />❑Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />New Vendor ❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Amendment No. 1 to Resolution No. 19-2016; Amendment to Water <br />Service and Sewer Service Agreement with Pokagon Band of Potawatomi <br />Project Name Indians (the "Band") and the Pokagon Gaming Authority (PGA) <br />Project Number <br />Funding Source <br />Account No. <br />Amount Refer to Easement Agreement regarding contributions and payment terms <br />Terms of Contract Refer to Easement Agreement regarding terms and conditions <br />Purpose/Description Public Works requests the approval of the subject Amendment No. 1 to a an <br />existing Water Service and Sewer Service Agreement which further defines <br />the obligations of the City, the Band and PGA under the water service and <br />sewer service agreement with respect to the Full Build -Out Phase of the Four <br />Amount of <br />Previous Amount <br />❑ Increase <br />❑ Decrease <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />For Change Orders <br />Increase % <br />Decrease ( %) <br />Increase <br />