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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: March 7th, 2023 <br />Name: Rebecca Maenhout Department of Public Works – Engineering Division <br />BPW Date: March 14th, 2023 <br />Phone Extension: 5996 or <br />rmaenhout@southbendin.gov <br /> <br />Required Prior to Submittal to Board BPW Attorney X Attorney Name Michael Schmidt <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 <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 Coal Line Trail Phase 3 <br />Project Number 123-007 (INDOT DES #2201235) <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description Proposal opening for PE (design) phase of above project. This is a <br />federally-funded LPA project following INDOT’s RFP guidelines. <br />Once a consultant has been selected, a contract will be drafted and <br />will be approved by the BPW at a later date. <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 />