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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11-04-24 <br />Name Ken Smith Department Water <br />BPW Date l l /l 2/24 Phone Extension 6108 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney <br />® Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ® Mickey Lovy <br />Michael Schmitt <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: Emergencv Repair 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 />Purpose/Description <br />Information <br />Milestone <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />MBE <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Emergency 24" Water Main Repair <br />2024 Water O&M <br />620-06-604-606-43 9001 <br />$91,290.34 <br />Emergencv <br />Emergency 24" line stops on water main due to failed 24" main line valve. Al <br />8" fire line valve failed that fed the South Bend Medical Foundation causing <br />leak on N Lafayette. This would significantly affect Memorial Hospital if not <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 />New Completion Date: <br />For Change Orders <br />Increase <br />Decrease <br />Increase <br />Decrease <br />