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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: <br />Name <br />11/15/2023 <br />Gemma Stanton <br />Department of Public Works — Engineering Division <br />BPW Date: November 28th, 2023 Phone Extension: 9083 <br />Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name Michael Schmidt <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />I Check the ADDroDriate Item TvDe — Reauired for All Submissions I <br />N 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 Lochmueller <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 />Purpose/Description <br />Information <br />U Yes U If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached ❑ Nos <br />Coal Line Trail Phase 3 <br />123-007 (INDOT DES #2201235) <br />TIF-River West <br />324-431002 1 PR-00029060 <br />$349,710 <br />LumD sum <br />Award PSA for design of Coal Line Trail Phase 3. This is a project <br />with INDOT that is eligible for 80% reimbursement of the PSA <br />amount. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />