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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/16/2024 <br />Name Zach Hurst Department DPW <br />BPW Date 01/23/2024 Phone Extension 3057 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney ® Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Michael Schmidt <br />Purchasing ❑ <br />Check the Appropriate Item Type — Requir, <br />❑ Professional Services Agreement ❑ Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />❑ Quote Opening ❑ Quote Award <br />❑ Proposal Opening ❑ C/O & PCA No. <br />❑ Chg. Order, No. ❑ Traffic Control <br />® Other: Right of Entry for <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 />Information <br />Jerid Enternrises LLC <br />All Submissions <br />U Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />❑ Ease./Encroach <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Demolition of 1000 W. Sample St. — Former Fun FX Building <br />123-014 <br />N/A <br />Purpose/Description This right of entry allows a BPW contractor onto the parcels adjacent to the <br />former Fun F/X building for purposes of demolition through Indiana's Unsafe <br />Building Law <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 />