Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/30/2022 <br />Name Leslie Biek Department PW <br />BPW Date 3/31/2022 Phone Extension 9323 <br /> <br />Required Prior to Submittal to Board BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br /> <br />Purchasing Michael Schmidt <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 INDOT <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 Bendix Drive Improvements (Lathrop to Voorde) <br />Project Number 121-047 (INDOT DES 2100022) <br />Funding Source <br />Account No. <br />Amount Up to $624,000 of federal funds to be reimbursed <br />Terms of Contract 80/20 cost share <br />Purpose/Description _INDOT/LPA agreement to provide 80% of the eligible project cost for the <br />Bendix Ph 2 PE phase of the project______ <br />_______________________________________________________________ <br />____________________________ <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <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 />