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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/25/2025 <br />Name Dan Jones Department PW <br />BPW Date 4/8/2025 Phone Extension 9245 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Michael Schmidt <br />Dept. Attorney Attorney Name <br />Purchasing <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 <br />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 />Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name Indiana Department of Transportation <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 2025 Community Crossings <br />Project Number 125-004 <br />Funding Source LRS <br />Account No. <br />Amount $1,500,000 <br />Terms of Contract <br />Purpose/Description The Community Crossings Matching Grant (CCMG) 50/50 cost share up to <br />$1,500,000 for the road rehabilitation of various City streets. <br />For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase % <br />Decrease ( %) <br />New Amount $ <br />Total Percent of Change: <br />Increase % <br />Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: