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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/7/2021 <br />Name Sue Ellen Doudrick on behalf of I&M <br />Department <br />Engineering <br />BPW Date 4/13/2021 Phone Extension <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney 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: I&M Memorandum of Use and License Agreement Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />Indiana Michigan Power Company, a subsidiary of American Electric <br />Power Incorporated <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 Muessel Colfax 69kV Transmission Line Project Phase I, II, & III <br />Project Number DP18-107 <br />Funding Source N/A <br />Account No. N/A <br />Amount N/A <br />Terms of Contract N/A <br />Purpose/Description I&M is installing a transmission line via open trench, horizontal direction drill, and jack & <br />bore methods from the Muessel Substation on Elwood to their Colfax Substation. The <br />alignment impacts several rights-of-way and city and private properties along the way. This <br />agreement covers the Civil City property and right-of-way areas. I&M plans to present this <br />agreement to Board of Park Commissioners for impacts to Parks properties at the next mtg. <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: