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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: May 18, 2021 <br />Name: Finnian Cavanaugh Department of Public Works – Engineering Division <br />BPW Date: May 25, 2021 Phone Extension: 5961 or 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: Right-of-Entry Approval Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor <br /> <br />MBE <br /> <br />WBE <br />Completed E-Verify Form Attached Yes <br /> No <br />Project Name Lincoln Way West and Olive Streetscape <br />Project Number 119-108 <br />Funding Source N/A: No financial routing required for Right of Entry Agreement <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description Right of Entry form for 2501 Lincoln Way West related to project <br />#119-108. Sidewalk removal and replacement as part of <br />streetscape will partially extend into private property. No financial <br />routing required. Board approval and signature is requested. <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 />