Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/21/2024 <br />Name Zach Hurst <br />Department DPW <br />BPW Date 05/28/2024 <br />Phone Extension 3057 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer <br />Officer Name <br />BPW Attorney ® <br />Attorney Name <br />Michael Schmidt <br />Dept. Attorney ❑ <br />Attorney Name <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type <br />— Re uired or All Submissions <br />® Professional Services Agreement <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />❑ Other: <br />❑ Contract ❑ Proposal <br />® Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Award ❑ Reject Bids/Quotes <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control ❑ Resolution <br />❑ Ease./Encroach <br />Reauired Information <br />Company or Vendor Name American Structurepoint <br />New Vendor ❑ Yes[:] If Yes, Approved by Purchasing <br />® No <br />MBE/WBE Contractor ❑ MBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Project Name South Bend Medical Foundation Demolition <br />Project Number 123-076 <br />Funding Source River West DA TIF <br />Account No. PO-0029313 <br />Amount This Change: $72,470; Revised Amount: $401,510 <br />Terms of Contract <br />Purpose/Description This amendment adds in additional design and survey services, soil borings, <br />and utility coordination. <br />For Chance Orders Onl <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />