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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br /> <br />Date September 13, 2022 <br />Name Leslie Biek, PE Department PW <br />BPW Date September 27, 2022 Phone Extension <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney Attorney Name <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. 1-3 Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name INDOT (Contractor is Milestone) <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 Olive St Reconstruction Ph 2 <br />Project Number 114-064, PROJ 58 <br />Funding Source River West TIF <br />Account No. PO 15217 <br />Amount <br />Terms of Contract <br />Purpose/Description These change orders are to replace the concrete mix (CO 1 & 2) and remove <br />and replace five castings instead of adjusting to grade due to existing <br />condition (CO #3). <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ 5,167.65 ($1,033.53 local funds) <br />($ ) <br />Previous Amount $ 655,280.20 <br />Current Percent of Change: <br />Increase <br />Decrease <br />0.789% <br />( %) <br /> New Amount $ 660,447.85 <br />Total Percent of Change: <br />Increase <br />Decrease <br /> % <br />( %) <br /> Time Extension Amount: <br />New Completion Date: <br />