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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: October 14, 2021 <br />Name: Finnian Cavanaugh Department of Public Works — Engineering Division <br />Phone Extension: 5961 or <br />BPW Date: October 26, 2021 fcavanau@asouthbendin.gov <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Anoromiate Item Tvne — Reauired for All Submissions I <br />U Professional Services Agreement U 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 />F-1 Other: n 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 />Information <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />E] MBE F-1 WBE Completed E -Verify Form Attached F-1No <br />100 S Michigan Tree Grates <br />121-037 <br />PR -00012634 <br />324-10-102-121-442001--PROJ00000288 <br />NTE <br />Quote opening for project to demolish raised tree planters and replace <br />with tree grates on the west side of the 100 S block of Michigan St. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: <br />Decrease ( % <br />New Amount <br />$ <br />Increase % <br />Total Percent of Change: <br />Decrease ( % <br />Time Extension Amount: <br />New Completion Date: <br />