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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 03-29-2024 <br />Name: Jacob M. Klosinski Department of Public Works — Engineering Division <br />BPW Date: 04-09-2024 Phone Extension: 9496 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney ® Attorney Name <br />Michael Schmidt <br />Purchasing ® Mickey Low / 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 />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 />Information <br />❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />❑❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />Fellows Booster Pump Station — Contract A (Pump Station Procurement) <br />121-070A / PROJ00000032 <br />State Revolving Fund & Water Capital Fund 622 <br />PR/PO # <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 receive and open Public Bids for the <br />Project 121-070A Fellows Booster Pump Station — Contract A (Pump Station <br />Procurement) at its regular meetinL- on 04/09/2024. <br />Amount of <br />Previous Amount <br />❑ Increase <br />❑ Decrease <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Comnletion Date: <br />For Change Orders <br />Increase % <br />Decrease ( %) <br />Increase % <br />Decrease ( %) <br />