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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/14/23 <br />Name Scott Kreeger <br />Department Public <br />Works <br />BPW Date 8/22/23 Phone Extension 9245 <br /> <br />Required Prior to Submittal to Board BPW Attorney Attorney Name Michael Schmidt <br />Dept. Attorney Attorney Name <br /> <br />Purchasing Michael Schmidt <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: Memorandum Ease./Encroach <br />Required Information <br />Company or Vendor Name Indiana Department of Transportation <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 Michigan Street Repaving <br />Project Number 123-066 (DFO Proj 420) <br />Funding Source Southside Development TIF <br />Account No. 430-10-102-121-442001 <br />Amount $978,930.17 <br />Terms of Contract Unit Price <br />Purpose/Description _Memorandum of Understanding with INDOT for the additional paving of US <br />31 (Michigan St) from INDOT project limits to Chippewa <br />Ave___________________________________________________________ <br />_____________________ <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <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 />