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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/5/2023 <br />Name Kieran Fahey <br />Department Public <br />Works <br />BPW Date 6/13/2021 Phone Extension 5993 <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney Attorney Name M Schmidt <br />Dept. Attorney Attorney Name M Schmidt <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: Preliminary <br />engineering report Public meeting <br />for CSO funding- BPW <br />resolution post meeting <br /> Ease./Encroach <br />Required Information <br />Company or Vendor Name Indiana Finance Authority/American Structurepoint/The Public <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 WWTP CSO tank <br />Project Number 121-071 <br />Funding Source No dollars <br />Account No. NA <br />Amount NA <br />Terms of Contract Board to (please) sign off on the recently held PER public meeting <br />held at last BPWs meeting <br />Purpose/Description As above <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: Increase %