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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/14/2025 <br />Name Dan Jones Department DPW <br />BPW Date 7/22/2025 Phone Extension 9323 <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 />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 />U Yes U If Yes, Approved by Purchasing <br />❑ No <br />❑❑ ❑ <br />MBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Mayflower Road to State Line Reconstruction <br />125-037: PROJ640 <br />PR-41400 <br />$600,000 <br />RTA; advertising 7/25 and 8/1 for bids due 8/12. <br />❑ CITY OF SOUTH BEND, INDIANA <br />Amount of Increase BOARD OF PUBLIC WORKS <br />❑ Decrease y� _ <br />Previous Amount $ 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 />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Breana Micou, Member <br />Attest: Madeline Hostetler, Acting Clerk _ <br />Date: July 22, 2025 <br />