Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/05/2024 <br />Name Becca Plantz Department Public Works <br />BPW Date 02/13/2024 Phone Extension 5998 <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney Attorney Name Michael Schmidt <br />Dept. Attorney Attorney Name <br /> <br />Purchasing <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: Deed of Dedication Ease./Encroach <br />Required Information <br />Company or Vendor Name 3502 Oakcrest Dr. South Bend, IN 46615 <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 3502 Oakcrest Dr. Deed of Dedication <br />Project Number n/a <br />Funding Source n/a <br />Account No. n/a <br />Amount $1.00 <br />Terms of Contract n/a <br />Purpose/Description Deed of Dedication to dictate ROW along 35th Street. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <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 />