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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: March 19, 2021 <br />Name: Finnian Cavanaugh Department of Public Works – Engineering Division <br />BPW Date: March 23, 2021 <br />Phone Extension: 5961 or <br />fcavanau@southbendin.gov <br /> <br />Required Prior to Submittal to Board BPW Attorney X Attorney Name Clara McDaniels <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 Abonmarche Consultants <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 Pavement Coring for Internal Paving 2021 <br />Project Number 121-027A <br />Funding Source Engineering: Other Professional Services <br />Account No. 251-06-600-506-431000-- (PR-00008047) <br />Amount $36,240.00 <br />Terms of Contract NTE <br />Purpose/Description PSA for asphalt pavement coring to be performed in Spring 2021 to <br />identify HMA thicknesses and direct milling. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br />% <br />( %) <br /> New Amount $ <br />Total Percent of Change: <br />Increase <br />Decrease <br />% <br />( %) <br /> Time Extension Amount: <br />New Completion Date: <br />