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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 18, 2021 <br />Name Jeff Hudak <br />Department Central <br />Services <br />BPW Date May 25 <br />2021 <br />Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer <br />❑ <br />Officer Name <br />BPW Attorney <br />® <br />Attorney Name <br />Clara McDaniels <br />Dept. Attorney <br />❑ <br />Attorney Name <br />Purchasing <br />® <br />Michael Schmidt <br />Check the Appropriate <br />Item Type <br />-- Required_fol- 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 />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />uired Information <br />❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />F-1 WBE Completed E -Verify Form Attached ❑❑ Nos <br />Spec C — Three (3) More or Less 2021 or Newer Utility Crew Trucks <br />Sewers -Cash Streets - Lease <br />Sewers — 642-06-602-509-445000 Streets — 202-06-602-503-445000 <br />Sewers - $77,500.00 Streets - $155,000.00 <br />_Spec C — Three (3) More or Less 2021 or Newer Utility Crew Trucks <br />® For Change Orders Only <br />Amount of ❑ CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Previous Amount vl .a <br />Current Percent of Change: Elizabeth A. Maradik, President <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Gary A. Gilot, Member <br />ME 01 <br />New Completion Date: Joseph R. Molnar, Member <br />M <br />Jordan V. Gathers, Member <br />Murray L. Miller, Member <br />Attest: Anne Fuchs, Clerk <br />