Request to Advertise & Title Sheet - CSO 18 Backwater Valve Replacement Proj No. 120-017

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date: 07-30-2021 Name: Jacob M. Klosinski, P.E. Department of Public Works — Engineering Division BPW Date: 08-10-2021 Phone Extension: Ext. 9496 Required Prior to Submittal to Board BPW Attorney X Attorney Name Clara McDaniels Dept. Attorney ® Attorney Name Purchasing ® Michael Schmidt Clara McDaniels Check the Appropriate Item Type — Required. for All Submissions ❑ Professional Services Agreement ❑ Contract ❑ Proposal ❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA ❑ Bid Opening ❑ Bid Award ® Req. to Advertise ® Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes ❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution F-1 Other: n Ease./Encroach Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Information U YesU If Yes, Approved by Purchasing ❑ No ❑❑ WBE Completed E -Verify Form Attached ❑❑ Nos CSO 18 Backwater Valve Replacement 120-017 641-06-605-514-439001 PR #00010974 /PO # TBD Refer to Purchase Requisition, Price will be based on awarded quotation. Lumn Sum and Unit Price Purpose/Description Div. of Engineering and Div. of Utilities submits a request to advertise for the receipt of quotations for the subject project for the replacement of the CSO 18 Backwater Valve. Refer to Memorandum and Quote Documents. For Change Orders Only ❑ CITY OF SOUTH BEND, INDIANA Amount of n BOARD OF PUBLIC WORKS Previous Amount -x,1,1. (4 Current Percent of Change: New Amount Elizabeth A. Maradik, President Gary A. Gilot, Member Total Percent of Change: e�z P1 Time Extension Amount: New Completion Date: Joseph R. Molnar, Member E Jordan V. Gathers, Member Murray L. Miller, Member Attest: Anne Fuchs, Clerk