Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 4/19/2022 <br />Name: Finnian Cavanaugh Department of Public Works – Engineering Division <br />BPW Date: 4/26/2022 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: ROW Dedication Ease./Encroach <br />Required Information <br />Company or Vendor Name (Land transfer from) COSB Venues, Parks, and Arts <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 <br />Project Number 120-049 <br />Funding Source N/A <br />Account No. N/A <br />Amount N/A <br />Terms of Contract Right of Way Deed of Dedication <br />Purpose/Description Dedication of 3,898 Sq Ft of Right of Way to allow space for construction <br />of paved turnaround at alley, maintaining emergency vehicle access for <br />remaining Sampson St following demolition of vacated portion. Signed by <br />BPC at 4/18/2022 meeting. <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 />