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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/17/2025 <br />Name Larry Parker Department Sewer <br />BPW Date l l /25/2025 Phone Extension <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 ® Mickey Lovy <br />Check the Appropriate Item I <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />I -I Other: <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 />Michael Schmidt <br />❑ Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />❑ Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />No <br />2025 Sewer Insurance Lateral Repair Program <br />Sewage Works is soliciting applications from qualified vendors to participate in its <br />Sewer Lateral Repair Program at the rates herein for the 2026 calendar year. <br />ff For Change Orders Only <br />Amount of ❑ Increase CITY OF SOUTH BEND, INDIANA <br />❑ Decrease BOARD OF PUBLIC WORKS <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />$ V11.Vlik <br />Increa& <br />Decrees Elizabeth A. Maradik, President <br />Increa& <br />Decrea; <br />Gary A. Gilot, Member <br />New Completion Date: Murray L. Miller, Member <br />Nw I <br />Joseph R. Molnar, Vice President <br />Breana Micou, Member <br />Attest: Hillary R. Horvath, Clerk <br />Date: November 25, 2025 <br />