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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/26/2021 <br />Name Leslie Biek Department Engineering <br />BPW Date 3/23/2021 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer Officer Name <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <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 Sheet <br /> Quote Opening Quote Award Reject Bids/Quotes <br /> Proposal Opening C/O & PCA No. PCA <br /> Chg. Order, No. 7 Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name INDOT (Contractor Rieth Riley) <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 LRSA <br />Account No. 251-06600-506-431-000 <br />Amount $32,490.66 (City’s share is $6,498.13) <br />Terms of Contract Unit Price <br />Purpose/Description Adjustment to quantities for common excavation, subgrade treatment and <br />asphalt base.___________________________ <br />For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ 32,490.66 <br />($ ) <br />Previous Amount $ 3,177,505.39 (original contract price $3,135,729.00) <br />Current Percent of Change: <br />Increase <br />Decrease <br />1.04% <br />( %) <br /> <br />New Amount $ 3,209,996.05 <br />Total Percent of Change: <br />Increase <br />Decrease <br />2.37% <br />( %) <br />Time Extension Amount: <br />New Completion Date: