Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: <br />Name <br />11 /7/23 <br />Gemma Stanton <br />Department of Public Works — Engineering Division <br />BPW Date: November 28, 2023 Phone Extension: 9083 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />I Check the ADDroDriate Item Tvne — Reauired for All Submissions I <br />U Professional Services Agreement U Contract U 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 />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />uired Information <br />❑ Yes[:] If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Safe Routes to School — Muessel Primary and Holy Cross Area <br />122-006 (INDOT DES #1900447) <br />Purpose/Description Proposal opening for CE (construction inspection) phase of above <br />project. This is a federally -funded LPA project following INDOT's <br />RFP guidelines. Once a consultant has been selected, a contract will <br />be drafted and will be approved by the BPW at a later date. <br />For Change Orders Only_ <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease <br />Increase % <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />