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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/16/2023 <br />Department Public <br />Name Kieran Fahey Works <br />BPW Date 5/23/2021 Phone Extension 5993 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney <br />❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item I <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />® Other: Preliminary <br />engineering report Public <br />M Schmidt <br />M Schmidt <br />❑ Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />U Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />❑ Ease./Encroach <br />Company or Vendor Name <br />Indiana Finance Authority/American Structurepoint/The Public <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />❑ <br />MBE <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ Nos <br />❑ <br />Project Name <br />WWTP CSO tank <br />Project Number <br />121-071 <br />Funding Source <br />No dollars <br />Account No. <br />NA <br />Amount <br />NA <br />Terms of Contract <br />To hold a public meeting at the 5/23/2023 BPWs for public/interested <br />parties regarding the WWTP CSO tank funding request to Indiana <br />Finance Authority <br />Purpose/Description <br />As above <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Increase % <br />Decrease ( % <br />Increase % <br />