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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/16/2025 <br />Name Zach Hurst Department DPW <br />BPW Date 06/24/2025 Phone Extension 3057 <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 ❑ <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: n Ease./Encroach <br />Information <br />Company or Vendor Name <br />❑ Yes[] If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MB❑ <br />MBE/WBE Contractor <br />❑ E Completed E-Verify Form Attached ❑ Neos <br />Project Name <br />Demolition of 4022 Old Cleveland Road <br />Project Number <br />125-038 <br />Funding Source <br />River West DA TIF <br />Account No. <br />PR-00041653 <br />Amount <br />Terms of Contract <br />Lump Sum <br />Purpose/Description <br />Request to open quotes to demolish the single-family home at 4022 Old <br />Cleveland Road <br />For Change Orders Only <br />Amount of ❑ CITY OF SOUTH BEND, INDIANA <br />❑ BOARD OF PUBLIC WORKS <br />Previous Amount tjA�,a <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Elizabeth A. Maradik, President <br />� <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />/ <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />oPav f -li wdL / ficfinl <br />Attest: Hillary Horvath, Acting Clerk <br />Date: 06/24/2025 <br />