Change Order No 3 - Coal Line Trail, Phase IIB Proj No. 122-035 - Milestone Contractors INDOT

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 07/18/2023 Name Rebecca Maenhout Department Division/Bureau a171 MVITIOMW Engineering BPW Date 08/08/2023 Phone Extension 5996 Required Prior to Submittal to Board Legal ❑ Attorney Name: Michael Schmidt Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ❑ Michael Schmidt Check the Appropriate Item Type — Required for All Submissions ❑ Agreement Amendment ❑ Contract ❑ Proposal ❑ Addendum ❑ Professional Services ❑ Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑X Change Order No. 3 ❑ C/O & PCA No. ❑ PCA ❑ Ease/Encroach. ❑ Traffic Control: I-1 Other: Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description uired Information I N DOT B-44292 ❑ Yes ® No ❑ If Yes, Approved by Purchasing ❑ MBE ❑ WBE ❑ No ❑ Yes Name of Company B-44292 Coal Line Trail Phase 116 122-035 River West TIF 324-10-102-121-444000--PROJ00000018 $27,652.96 Change Order 3 covers the cost associated with reconstruction of Pier Cap 4 due to the Constructibility Issues. U Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) Required For Change Orders Only Amount of X❑ Increase $ 27,652.96 ❑ Decrease $ Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ❑ ❑ ❑ ❑ ❑ ❑ $ 3,473,501.03 0.802% $ 3,501,153.99 1.47% Dispersal After