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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br /> <br />Date 4/28/2024 <br />Name Gemma Stanton Department PW <br />BPW Date 5/14/2024 Phone Extension 9083 <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br /> <br />Purchasing 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. 4 Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name INDOT (Contractor is Selge) <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 Coal Line Trail Phase 2A <br />Project Number 115-064 DES1401811 <br />Funding Source <br />Account No. PO-0025244 <br />Amount $2,017,177.48 Total contract amount incl. CO 2 and CO3 <br />Terms of Contract <br />Purpose/Description See attached memo. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$82,640.84 (no additional local funds required) <br />($ ) <br />Previous Amount $1,934,536.64 <br />Current Percent of Change: <br />Increase <br />Decrease <br />4.871% <br />( %) <br /> New Amount $2,017,177.48 <br />Total Percent of Change: <br />Increase <br />Decrease <br />18.9% <br />( %) <br /> Time Extension Amount: <br />New Completion Date: <br />