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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/5/23 <br />Name Michael Schmidt <br />Department Lsgal <br />BPW Date May 9, 2023 <br />Phone Extension Ext. 5860 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer <br />Officer Name <br />BPW Attorney ® <br />Attorney Name <br />Michael Schmidt <br />Dept. Attorney ® <br />Attorney Name <br />Michael Schmidt <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type <br />— Re uired or All Submissions <br />❑ Professional Services Agreement <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />❑ Other: <br />® Contract ❑ Proposal <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Award ❑ Reject Bids/Quotes <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control ❑ Resolution <br />x❑ Ease./Encroach <br />Reauired Information <br />Company or Vendor Name <br />St. Joseph County Redevelopment and St. Joseph County Commissioners <br />❑ Yes[:] If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />Yes <br />MBE <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ ❑ No <br />Project Name <br />MOU on Sanitary Sewer Upgrade Study <br />Project Number <br />NA <br />Funding Source <br />Account No. <br />Amount <br />N/A <br />Terms of Contract <br />As attached <br />Purpose/Description <br />No fees to the City. <br />For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />$ <br />Increase % <br />Total Percent of Change: <br />Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />