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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 10/5/2021 <br />Name: Kieran Fahey Department of Public Works – Engineering Division <br />BPW Date: 10/12/2021 Phone Extension: 5993 <br /> <br />Required Prior to Submittal to Board BPW Attorney X Attorney Name <br />Clara McDaniels <br />Dept. Attorney Attorney Name Clara McDaniels <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: Ease./Encroach <br />Required Information <br />Company or Vendor Name American Structurepoint, Inc <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor MBE <br /> WBE Completed E-Verify Form Attached Yes <br /> No <br />Project Name LTCP Waste-water treatment plant storage tank <br />Project Number 121-071 <br />Funding Source LTCP engineering <br />Account No. PR/PO #641-06-605-514-431002 <br />Amount $203,735.00 <br />Terms of Contract Study phase to design WWTP CSO storage tank <br />Special Contract Provisions <br />Purpose/Description New Consent Decree for LTCP requires a tank to store combined sewage at <br />South Bend’s WWTP. This study phase will initiate and advance this design. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br /> % <br />( %) <br /> <br />New Amount $ <br />Total Percent of Change: <br />Increase <br />Decrease <br /> % <br />( %) <br /> <br />Time Extension Amount: <br />New Completion Date: <br />