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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 15, 2021 Department Public Works <br />Name Kyle Silveus Division/Bureau Engineering <br />BPW Date November 23, 2021 Phone Extension 9083 <br /> <br />Required Prior to Submittal to Board Legal Attorney Name: Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Michael Schmidt <br />Check the Appropriate Item Type – Required for All Submissions <br /> Agreement Contract Proposal Addendum <br /> Professional Services Resolution <br /> Bid Opening Bid Award Req. to Advertise Title Sheet <br /> Quote Opening Quote Award <br /> Change Order No. 1-3 C/O & PCA No. PCA <br /> Ease/Encroach. Traffic Control: <br /> Other: C <br />Required Information <br />Company or Vendor Name INDOT <br />New Vendor Yes No If Yes, Approved by Purchasing <br />MBE/WBE Contractor MBE WBE <br />MBE/WBE Contractor Requested No Yes Name of Company <br />Project Name Coal Line Trail Phase 1 <br />Project Number ENG: 115-063 DES No: 1401810 <br />Funding Source Riverwest TIF <br />Account No. 324-444000 <br />Amount $178,895.51 <br />Terms of Contract <br />Purpose/Description <br />Total fee not to exceed <br />Path change from Asphalt to Concrete, Light pole temperature <br />change, Tesco Cabinet <br /> <br /> <br /> Required Contractor’s Certification Forms Attached (Non- <br />Collusion, Non-Discrimination, Non-Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ 178,895.51 <br />$ <br />Previous Amount $ $1,623,701.34 <br />Current Percent of Change: 11.02% <br />New Amount $ 1,802,596.85 <br />Total Percent of Change: 11.02% <br />Dispersal After Approval <br />Copy Original <br /> Kyle Silveus <br /> Chris Dressel <br /> <br />