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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Aril 26 2021 <br />Department Central <br />Name Jeff Hudak Services <br />BPW Date May 11 2021 Phone Extension <br />Review and A �ro�al Re uired Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer Officer Name <br />BPW Attorney M Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ® Michael Schmidt <br />Check the Appropriate Item Type — Regt iced jar 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 Sheel <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 <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />E] MBE Yes <br />MBE/WBE Contractor <br />F] WBE Completed E -Verify Form Attached ❑ No <br />Project Name <br />Sec C — Three 3 More or Less 2021 or Newer Utility Crew Trucks <br />Project Number <br />Funding Source <br />Sewers - Cash Streets - Lease <br />Account No. <br />Sewers — 642-06-602-509-445000 Streets — 202-06-602-503-445000 <br />Amount <br />Sewers - $77;1500.00 Streets - $155,000.00 <br />Terms of Contract <br />Purpose/Description <br />—Spec C — Three (3) More or Less 2021 or Newer Utility Crew Trucks <br />For Change Orders Only <br />Amount Of ❑ <br />CITY OF SOUTH BEND, INDIANA <br />❑ <br />BOARD OF PUBLIC WORKS <br />Previous Amount <br />-1,'a <br />Current Percent of Change: <br />Elizabeth A. Maradik, President Jordan V. Gathers, Member <br />New Amount <br />Gary A. Gilot, Member Murray L. Miller, Member <br />Total Percent of Change: <br />Time Extension Amount: <br />New CamIetion Date: <br />Joseph R. Molnar, Member Attest: Anne Fuchs, Clerk <br />