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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 03-05-2024 <br />Name: Jacob M. Klosinski Department of Public Works – Engineering Division <br />BPW Date: 03-12-2024 Phone Extension: 9496 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney Attorney Name Michael Schmidt <br />Purchasing Mickey Lovy / Ron O'Connor <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: Ease./Encroach <br />Required Information <br />Company or Vendor Name <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 Fellows Booster Pump Station <br />Project Number 121-070 / PROJ00000032 <br />Funding Source State Revolving Fund & Water Capital Fund 622 <br />Account No. PR/PO # <br />Amount <br />Terms of Contract <br />Special Contract Provisions Indiana Finance Authority Special Provisions and MWBE Goals <br />Purpose/Description Public Works, the Division of Engineering and Division of Water Works <br />requests the Board of Public Works approve a Title Sheet and Request to <br />Advertise for the receipt of public bids for the Fellows Booster Pump Station <br />project. <br />For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br />% <br />(%) <br /> <br />New Amount $ <br />Total Percent of Change: <br />Increase <br />Decrease <br />% <br />(%) <br />Time Extension Amount: <br />New Completion Date: March 12, 2024