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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: April 1, 2022 <br />Name: Finnian Cavanaugh Department of Public Works – Engineering Division <br />BPW Date: April 12, 2022 Phone Extension: 5961 or fcavanau@southbendin.gov <br /> <br />Required Prior to Submittal to Board BPW Attorney X Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <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 Jones Petrie Rafinski Corp <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 Randolph Park Improvements (Design Services) <br />Project Number 120-049 <br />Funding Source PO-0005892 (addition from VPA Parks Bond Capital) <br />Account No. 471-11-206-288-444000--PROJ00000237 <br />Amount $4,500 additional <br />Terms of Contract NTE <br />Purpose/Description Additional design scope to perform boundary survey and produce Deed of <br />Dedication Plat for right-of-way at Randolph Park. Addition funded by <br />VPA. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$4,500.00 <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br />10% <br />( %) <br /> New Amount $ 44,185.00 <br />Total Percent of Change: <br />Increase <br />Decrease <br />10% <br />( %) <br /> Time Extension Amount: N/A <br />New Completion Date: <br />