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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/17/2025 <br />Name Zach Hurst Department DPW <br />BPW Date 11/25/2025 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. 4 ❑ 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 />Indiana Earth <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑❑ ❑ <br />MBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Beacon Health Parking Lot <br />123-076A <br />River West DA TIF <br />PO-0036234 <br />This change: $28,446; Revised Amount: $2,679,067.97 <br />Change Order #4 adds an additional light pole ($22,891) and sawcutting and <br />concrete removal at a utility vault on the parcel ($5,555). <br />For Chance Orders Onl <br />Amount of ® Increase $ 28,446 <br />❑ Decrease ($ ) <br />Previous Amount $ 2,650,621.97 <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase 1.07% <br />Decrease ( %) <br />$ 2,679,067.97 <br />Increase 13.18% <br />Decrease ( %) <br />