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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/29/2024 <br />Department Public <br />Name Scott <br />BPW Date 4/9/2024 Phone Extension 9245 <br />Required Prior to Submittal to Board <br />BPW Attorney <br />® <br />Attorney Name <br />Michael Schmidt <br />Dept. Attorney <br />❑ <br />Attorney Name <br />Purchasing <br />❑ <br />Mikey Low <br />Check the Appropriate <br />Item Type <br />— Re uired or All Submissions <br />❑ Professional Services Agreement <br />❑ Contract <br />❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />❑ Resolution <br />® Other: ROW Occupancy <br />and <br />❑ Ease./Encroach <br />Encroachment Agreement <br />Required Information <br />Wolfe House Movers of Indiana LLC. & Historic Landmarks Foundation <br />Company or Vendor Name of Indiana, Inc. <br />New Vendor ❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name N/A <br />Project Number N/A <br />Funding Source N/A <br />Account No. N/A <br />Amount N/A <br />Terms of Contract <br />Purpose/Description 1006 St. Vincent Street House Move Right -of -Way Occupancy an <br />Encroachment Agreement <br />For Change Orders Only <br />Amount of <br />❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease ( %) <br />Increase <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />New Completion Date: <br />