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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 09-01-2023 <br />Name: Jacob M. Klosinski, P.E. Department of Public Works — Engineering Division <br />BPW Date: 09-12-2023 Phone Extension: 9496 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney ® Attorney Name <br />Purchasing <br />® Mickey Low <br />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 />n Other: n Ease./Encroach <br />Information <br />Company or Vendor Name <br />N/A <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBE ❑❑ <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ Nos <br />Project Name <br />123-011 YSB and SB Thrive Subdivision <br />Project Number <br />PROJ465 <br />Funding Source <br />Fund 408 and ARP015 <br />Account No. <br />PR # 26650 <br />Amount <br />N/A <br />Terms of Contract <br />N/A <br />Special Contract Provisions <br />N/A <br />Purpose/Description Request for the Board of Public Works to receive and open bids for the <br />subject project for the Youth Services Bureau and South Bend Thrive <br />Subdivision public infrastructure project. <br />For Change Orders Onl <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase % <br />Decrease ( %) <br />Increase % <br />Decrease ( % <br />