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(b W- <br />OFFICE OF THE CONTROLLER AND <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 19, 2007 Department _Engineering <br />BPW Date Phone 235-5998 <br />June 25, 2007 � ,-r- <br />1855 <br />Name Jason J. Durr, P.E. <br />o _ Legal Attorney Name: 1 • (Q�� �� ' ��" J� �.r <br />L Controller review is required for all Contracts $5,000.00 or more and greater than one <br />U 3 ' -a Controller ❑ year in length per the City Purchasing Policy <br />S • 2 ° OTHER <br />Cr 0 APPROPRIATE ® Other, as appropriate <br />REVIEWERS <br />Type of Item. ❑Contract/Agreement ❑Proposal ❑Addendum ❑Claim <br />®Easement/Encroachment ❑Resolution ❑Traffic Control Device <br />Cn <br />-----_Other:---------------- ------------------------------------------------ -------------------- <br />Company or Vendor Name Indiana Michigan Power <br />a� a Project Name South Well Field Project <br />o Project Number (Engineering) 107-021 Proj. Code (Controller) <br />Amount $1.00 Funding Source <br />a u Purpose/Description: Indiana Michigan Power requires an easement on the South Well Field <br />U s-. rn <br />O Property in order to provide service. <br />------------------- <br />----------------------------- - --------------------------------------- <br />o q <br />U Terms of Contract: <br />------------------------- -------------------------------------------------------------- <br />Effective Date 6/25/07 End Date <br />[]Bid Award ❑Amendment ❑Title Sheet <br />Type of Item ❑Advertise ❑Bid Opening <br />�, ❑Other ------------------------------------------------------------------------------- <br />Company Name <br />o Project Name <br />Project Number (Engineering) Proj. Code (Controller) <br />Contract/Prpject Amount $ Funding Source <br />Type of Item ❑Chg-Order ❑C/0 & PCA ❑PCA Other: <br />Contractor/Consultant Name <br />Project Name <br />7:1 Project Number (Engineering) Proj. Code (Controller) <br />O PO Number Funding Source <br />Amount of ❑Increase ❑Decrease $ Total Percent of Change: <br />Original Contract/Project Amount $ <br />U New Contract/Project Amount $ <br />Purpose/Description: <br />List Name, Dept., Address (if appropriate) of who should receive document <br />nal <br />❑ John Wiltrout <br />Water Works <br />