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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/17/2024 <br />Name Becca Plantz Department Public Works <br />BPW Date 05/28/2024 Phone Extension 5998 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ Officer Name Cynthia Simmons <br />and Inclusion Officer <br />BPW Attorney <br />❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ Mickey Lovey <br />Check the Appropriate Item I <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />® Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />I -I Other: <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 />Purpose/Description <br />Michael Schmidt <br />❑ Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />U Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />Yes U If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached Yes <br />❑ No <br />South Bend — SBCSC Administration Building Renovation — Elevator <br />Replacement <br />124-OOIA <br />Economic Development LIT <br />PROJ 362 <br />Sum <br />Demolish existing elevator equipment and construct a pair of elevators in the <br />South Bend Community School Corp Building for City Hall renovations. <br />Ir For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Increase % <br />Decrease ( %) <br />Increase % <br />Decrease ( %) <br />New Completion Date: <br />