HomeMy WebLinkAboutAgreement - INDOT - Matching Grant Agreement for Ironwood Drive Improvements1316 COUNTY-(. rry BUILDING
227 W. JE]7FF.IZSON Bouu."VARD
SOUTI-i BEND. INDIANA 46601-1830
CITY OF Soun-i BEND PETE BUTTc'J=1EG, MAYA
BOARD Bb OF PULIC )'-( S
January 9, 2018
Marcia Blansett
Indiana Department of Transportation
PO Box 429
315 East Boyd Blvd.
LaPorte, IN 46352
RE: Agreement
Dear Ms. Blansett:
PHOW, 574/235-9251
FAX 574/ 235-9171
The Board of Public Works, at its meeting held on January 9, 2018, approved the above
referenced matching grant agreement for Ironwood Drive improvements North of Rockne
Drive to State Road 23 in the amount of $670,000.00
Enclosed please find the original of the agreement for your signature. Please sign and return
the original agreement to our office and retain a copy for your records.
If you have any further questions, regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
IL4--
1,inda M. Martin, Clerk
Enclosure
c: Roger Nawrot, Engineering
GARY A. Ga,o'r SUZANNA M. FRi,rZBERG ELIZABE'rii A. MARADIK JAmEs A. MUELLER THERESE J. DORAU
LOCAL ROADS AND BRIDGES MATCHING GRANT AGREEMENT
EDS # A249-
This local Roads and Bridges Matching Grant Agreement (this "Grant Agreement"), is made and entered
into effective as of the date of the Indiana Attorney General signature affixed to this Agreement by and
between the Indiana Department of Transportation (hereinafter referred to as the "State") and City of
South Bend, a Local Unit, (hereinafter referred to as the "Grantee"), and collectively referred to as the
Parties, is executed pursuant to the terms and conditions set forth herein. In consideration of those mutual
undertakings and covenants, the Parties agree as follows:
RECITALS
WHEREAS, Ind. Code § 8-23-30 establishes the Local Road and Bridge Matching Grant Fund,
one purpose of which is to enable the State to make matching grants to Local Units for Eligible Projects;
and
WHEREAS, the Grantee uses an approved transportation asset plan on file with the State; and
WHEREAS, the Grantee is a Local Unit as defined in Ind. Code § 8-23-30-1 and is eligible to
receive a grant; and
WHEREAS, the Grantee has submitted an application for an Eligible Project as defined in Ind.
Code § 8-23-30-1 (the "Project") and described in Attachment A, attached and incorporated by reference
to this Grant Agreement; and
WHEREAS, the Grantee has committed matching funds from one of the following revenue
sources in accordance with Ind. Code § 8-23-30-3: (1) any money the local unit is authorized to use for a
local road or bridge project; (2) special distribution of local income tax under Ind. Code § 6-3.6-9-17; or
(3) local rainy day fund under Ind. Code § 36-1-8-5.1; and
WHEREAS, the State has chosen to fund the Grantee's Project in accordance with the terms of
this Grant Agreement; and
WHEREAS, the Grantee desires to expedite delivery of the Project, comply with all State
requirements and fiscally manage the Project;
NOW THEREFORE, in consideration of the mutual covenants and promises herein contained,
the Grantee and the State agree as follows:
The "Recitals" above are hereby made an integral part and specifically incorporated into this Grant
Agreement.
1. Purpose of this Grant Agreement; Grant Funds.
The purpose of this Grant Agreement is to enable the State to award a grant to the Grantee, representing
50% of the eligible costs of the Project described in Attachment A of this Grant Agreement, which is
incorporated fully by reference. The funds shall be used exclusively in accordance with the provisions
contained in this Grant Agreement and in conformance with Ind. Code § 8-23-30 establishing the authority
to make this Grant, as well as any program requirements as identified by the State. The funds received by
the Grantee pursuant to this Grant Agreement shall be used only to implement the Project in conformance
with this Grant Agreement and for no other purpose.
Page 1 of 9
2. Representations and Warranties of the Grantee.
A. The Grantee expressly represents and warrants to the State that it is statutorily eligible to receive
these Grant funds and that the information set forth in its grant application is true, complete and accurate.
The Grantee expressly agrees to promptly repay all funds paid to it under this Grant Agreement should it
be determined either that the Grantee was ineligible to receive the funds, or made any material
misrepresentation on its grant application.
B. The Grantee certifies by entering into this Grant Agreement that neither it nor its officials,
employees, agents or principals are presently debarred, suspended, proposed for debarment, declared
ineligible or voluntarily excluded from entering into this Grant Agreement by any federal or state
department or agency. The term "principal" for purposes of this Grant Agreement is defined as an officer,
director, owner, partner, key employee or other person with primary management or supervisory
responsibilities, or a person who has a critical influence on or substantive control over the operations of the
Grantee.
C. The Grantee certifies by entering into this Grant Agreement that its contractors and
subcontractors have been prequalified to perform work pursuant to Ind. Code § 8-23-10.
D. The Grantee shall file the annual financial report required by Ind. Code § 5-11-1-4 in
accordance with the State Board of Accounts Uniform Compliance Guidelines for Examination of
Entities Receiving Financial Assistance from Governmental Sources. All grant documentation shall be
retained and trade available to the State Board of Accounts if and when requested.
3. Implementation of and Reporting on the Project.
The Grantee shall implement and complete the Project in accordance with Attachment A. Modification of
the Project shall require prior written approval of the State.
4. Term.
This Grant Agreement commences on the date approved by the State Budget Agency, and shall remain in
effect for two (2) years. Unless otherwise provided herein, it may be extended upon the written agreement
of the parties and in conformance with Ind. Code § 5-22-17-4, and as permitted by Ind. Code § 8-23-30.
The Grantee understands that the Grantee must procure materials and/or a contractor for the Project no later
than April 15, 2018. If the Grantee fails to procure a contractor by April 15, 2018, the Grantee forfeits the
Grant, the grant funds shall not be distributed to the Grantee, but shall be redistributed as all other funds
under Indiana Code § 8-23-30.
5. Grant Funding.
Pursuant to Ind. Code § 8-23-30, the Grantee agrees to the following:
A. It may use the State funds only for the Project described in Attachment A;
B. If it uses the grant funds for any purpose other than construction of the Project as described in
Attachment A, the Grantee:
i. must immediately repay all grant funds provided to the State; and
Page 2 of 9
ii. may not participate in the grant program during the succeeding fiscal year.
C. It shall provide local matching funds equal to not less than 50% of the estimated project cost;
D. Disbursement of grant funds will not be made until the Grantee's submission of an
accepted/awarded Project Material Bid and/or an executed contract with the contractor;
E. The State's participation in the Project is strictly limited to the grant funds awarded herein. The
Grantee understands and agrees that the State is under no obligation to pay for or participate in
any cost increases, change orders, cost overruns or additional Project expenses of any kind.
6. Payment of Claims.
A. All payments shall be made as required by Ind. Code § 4-13-2-14.8, by electronic funds transfer
to the financial institution designated by the Grantee in writing. After such funds have been expended,
Grantee shall provide the State with a reconciliation of those expenditures.
B. Upon the State's receipt of Grantee's accepted/awarded bid for the Project, requests for payment
will be processed only upon presentation of a Claim Voucher in the form designated by the State.
C. All final reports must be submitted to the State prior to the expiration or termination of this
agreement. If Grant funds have been paid to the Grantee and are unexpended at the time that the final claim
is submitted, all such unexpended grant funds must be returned to the State in accordance with this Grant
Agreement.
D. Pursuant to Ind. Code § 8-23-30, Local Road and Bridge Grant Funds made available to the
Grantee by the State will be used to pay the Grantee for up to 50% of the eligible Project costs and not
more than $1 million. The maximum amount of state funds allocated to the Project is $ 670,000.00.
E. Pursuant to Ind. Code § 8-23-30-3, the Grantee's 50% match shall be paid from one of the
identified revenue sources. The remainder of the Project costs greater than the total of the State's grant and
the Grantee's 50% match shall be borne by the Grantee and may be paid how the Grantee chooses. In the
interest of clarity and to avoid misunderstanding, the State shall not pay the Grantee for any costs relating
to the Project except as specifically provided herein, unless the Parties enter into an amendment to this
Grant Agreement,
F. The Grantee understands that maximum amount of Local Road and Bridge Grant funds may
not exceed more than $1 million for all qualifying projects the Grantee may have in a fiscal year.
7. Project Monitoring by the State.
The State may conduct an on -site review of the Project once construction is completed. The Grantee shall
extend its full cooperation and give full access to the Project site and to relevant documentation to the State
or its authorized designees for the purpose of determining, among other things:
A. whether Project activities are consistent with those set forth in Attachment A, the grant
application, and the terms and conditions of the Grant Agreement;
B. the actual expenditure of state, and local funds expended to date on the Project is in conformity
with the amounts as set forth in Attachment A;
Page 3 of 9
S. Audits and Maintenance of Records.
A. Grantee shall submit to an audit of funds paid through this Grant Agreement, and shall make
all books, accounting records and other documents available at all reasonable times during the term of this
Grant Agreement and for a period of five (5) years after final payment for inspection by the State or its
authorized designee or final audit by State Board of Accounts, whichever is later. Copies shall be furnished
to the State at no cost.
B. A final audit construction invoice detailing the actual costs of construction and proof of
payment to the contractor must be submitted to the State within thirty (30) days of completion of the Project.
If for any reason, including overpayment of grant funds to the Grantee, the Grantee is required to repay to
the State the sum or sums of state funds paid to the Grantee under the terms of this Grant Agreement, then
the Grantee shall repay to the State such sum or sums within forty-five (45) days after receipt of a billing
from the State. Payment for any and all costs incurred by the Grantee which are not eligible for state
funding shall be the sole obligation of the Grantee.
C. If for any reason the State finds noncompliance and requires a repayment of state funds
previously paid to the Grantee, the Grantee is required to submit such sum or sums within thirty (30) days
after receipt of a billing from the State. If the Grantee has not paid the full amount due within sixty (60)
calendar days past the due date, the State may proceed in accordance with Ind. Code § 8-14-1-9 to compel
the Auditor of the State of Indiana to make a mandatory transfer of funds for the Grantee's allocation of the
Motor Vehicle Highway Account to the State's Local Road and Bridge Matching Grant Fund account until
the amount due has been repaid.
9. Compliance with Laws.
A. The Grantee shall comply with all applicable federal, state and local laws, rules, regulations
and ordinances, and all provisions required thereby to be included herein are hereby incorporated by
reference. The enactment or modification of any applicable state or federal statute or the promulgation of
rules or regulations thereunder after execution of this Grant Agreement shall be reviewed by the State and
the Grantee to determine whether the provisions of this Grant Agreement require formal modification.
B. The Grantee and its agents shall abide by all ethical requirements that apply to persons who
have a business relationship with the State as set forth in Ind. Code § 4-2-6, et seq., Ind. Code § 4-2-7, et
seq. and the regulations promulgated thereunder. If the Grantee has knowledge, or would have acquired
knowledge with reasonable inquiry, that a state officer, employee, or special state appointee, as those
terms are defined in Ind. Code § 4-2-6-1, has a financial interest in the Grant, the Grantee shall
ensure compliance with the disclosure requirements in Ind. Code § 4-2-6-10.5 prior to the execution
of this grant. If the Grantee is not familiar with these ethical requirements, the Grantee should refer any
questions to the Indiana State Ethics Commission, or visit the Inspector General's website at
http://www,in.gov/i . If the Grantee or its agents violate any applicable ethical standards, the State may,
in its sole discretion, terminate this Grant immediately upon notice to the Grantee. In addition, the Grantee
may be subject to penalties under Ind. Code §§ 4-2-6, 4-2-7, 35-44.1-1-4, and under any other applicable
laws.
Page 4 of 9
C. The Grantee warrants that the Grantee and any contractors performing work in connection with
the Project shall obtain and maintain all required permits, licenses, registrations, and approvals, and shall
comply with all health, safety, and environmental statutes, rules, or regulations in the performance of work
activities for the State. Failure to do so may be deemed a material breach of this Grant Agreement and
grounds for immediate termination and denial of grant opportunities with the State.
D. As required by Ind. Code § 5-22-3-7:
(1)The Grantee and any principals of the Grantee certify that:
(A) the Grantee, except for de minimis and nonsystematic violations, has not violated
the terms of:
(i) Ind. Code § 24-4.7 [Telephone Solicitation of Consumers];
(ii) Ind. Code § 24-5-12 [Telephone Solicitations]; or
(iii) Ind. Code § 24-5-14 [Regulation of Automatic Dialing Machines];
in the previous three hundred sixty-five (365) days, even if Ind. Code § 24-4.7 is
preempted by federal law; and
(B) the Grantee will not violate the terms of Ind. Code § 24-4.7 for the duration of
this Grant Agreement, even if Ind. Code § 24-4.7 is preempted by federal law.
(2)The Grantee and any principals of the Grantee certify that an affiliate or principal of the
Grantee and any agent acting on behalf of the Grantee or on behalf of an affiliate or
principal of the Grantee, except for de minimis and nonsystematic violations,
(A) has not violated the terms of Ind. Code § 24-4.7 in the previous three hundred
sixty-five (365) days, even if Ind. Code § 24-4.7 is preempted by federal law; and
(B) will not violate the terms of Ind. Code § 24-4.7 for the duration of this Grant
Agreement even if Ind. Code § 24-4.7 is preempted by federal law.
10. Drug -Free Workplace Certification.
This clause is required by Executive Order 90-5 and applies to all individuals and private legal entities who
receive grants or contracts from State agencies. This clause was modified in 2005 to apply only to Grantee's
employees within the State of Indiana and cannot be further modified, altered or changed.
As required by Executive Order No. 90-5, April 12, 1990, issued by the Governor of Indiana, the Grantee
hereby covenants and agrees to make a good faith effort to provide and maintain a drug -free workplace.
Grantee will give written notice to the State within ten (10) days after receiving actual notice that the
Grantee, or an employee of the Grantee in the State of Indiana, has been convicted of a criminal drug
violation occurring in the workplace. False certification or violation of the certification may result in
sanctions including, but not limited to, suspension of grant payments, termination of the Grant and/or
debarment of grant opportunities with the State of Indiana for up to three (3) years.
In addition to the provisions of the above paragraphs, if the total amount set forth in this Grant Agreement
is in excess of $25,000.00, the Grantee certifies and agrees that it will provide a drug -free workplace by:
A. Publishing and providing to all of its employees a statement notifying them that the unlawful
manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited
in the Grantee's workplace and specifying the actions that will be taken against employees for
violations of such prohibition; and
Page 5 of 9
B. Establishing a drug -free awareness program to inform its employees of (1) the dangers of drug
abuse in the workplace; (2) the Grantee's policy of maintaining a drug -free workplace; (3) any
available drug counseling, rehabilitation, and employee assistance programs; and (4) the
penalties that may be imposed upon an employee for drug abuse violations occurring in the
workplace; and
C. Notifying all employees in the statement required by subparagraph (A) above that as a
condition of continued employment the employee will (1) abide by the terms of the statement;
and (2) notify the Grantee of any criminal drug statute conviction for a violation occurring in
the workplace no later than five (5) days after such conviction; and
D. Notifying in writing the State within ten (10) days after receiving notice from an employee
under subdivision (C)(2) above, or otherwise receiving actual notice of such conviction; and
E. Within thirty (30) days after receiving notice under subdivision (C)(2) above of a conviction,
imposing the following sanctions or remedial measures on any employee who is convicted of
drug abuse violations occurring in the workplace: (1) take appropriate personnel action against
the employee, up to and including termination; or (2) require such employee to satisfactorily
participate in a drug abuse assistance or rehabilitation program approved for such purposes by
a federal, state or local health, law enforcement, or other appropriate agency; and
F. Making a good faith effort to maintain a drug -free workplace through the implementation of
subparagraphs (A) through (E) above.
11. Employment Eligibility Verification.
As required by Ind. Code § 22-5-1.7, the Grantee hereby swears or affirms under the penalties of perjury
that:
A. The Grantee has enrolled and is participating in the E-Verify program;
B. The Grantee has provided documentation to the State that it has enrolled and is participating in
the E-Verify program;
C. The Grantee does not knowingly employ an unauthorized alien.
D. The Grantee shall require its contractors who perform work under this Grant Agreement to
certify to Grantee that the contractor does not knowingly employ or contract with an
unauthorized alien and that the contractor has enrolled and is participating in the E-Verify
program. The Grantee shall maintain this certification throughout the duration of the term of a
contract with a contractor.
The State may terminate for default if the Grantee fails to cure a breach of this provision no later than thirty
(30) days after being notified by the State.
12. Funding Cancellation.
When the Director of the State Budget Agency makes a written determination that funds are not
appropriated or otherwise available to support continuation of performance of this Grant Agreement, it shall
Page 6 of 9
be canceled. A determination by the Director of the State Budget Agency that funds are not appropriated
or otherwise available to support continuation of performance shall be final and conclusive.
13. Governing Law.
This Grant Agreement shall be governed, construed, and enforced in accordance with the laws of the State
of Indiana, without regard to its conflict of laws rules. Suit, if any, must be brought in the State of Indiana.
14. Nondiscrimination.
Pursuant to the Indiana Civil Rights Law, specifically including Ind. Code § 22-9-1-10, and in keeping
with the purposes of the federal Civil Rights Act of 1964, the Age Discrimination in Employment Act, and
the Americans with Disabilities Act, the Grantee covenants that it shall not discriminate against any
employee or applicant for employment relating to this Grant with respect to the hire, tenure, terms,
conditions or privileges of employment or any matter directly or indirectly related to employment, because
of the employee or applicant's: race, color, national origin, religion, sex, age, disability, ancestry, status as
a veteran, or any other characteristic protected by federal, state, or local law ("Protected Characteristics").
Furthermore, Grantee certifies compliance with applicable federal laws, regulations, and executive orders
prohibiting discrimination based on the Protected Characteristics in the provision of services.
The Grantee understands that the State is a recipient of federal funds, and therefore, where applicable,
Grantee and any subcontractors shall comply with requisite affirmative action requirements, including
reporting, pursuant to 41 CFR Chapter 60, as amended, and Section 202 of Executive Order 11246 as
amended by Executive Order 13672.
15. Notice to Parties.
Whenever any notice, statement or other communication is required under this Grant, it shall be sent by
first class mail or via an established courier / delivery service to the following addresses, unless otherwise
specifically advised.
A. Notice to the State, regarding contract provisions shall be sent to:
Office of LPA/MPO and Grant Administration
Attention: Director of LPA/MPO and Grant Administration
100 North Senate Avenue, Room N955
Indianapolis. IN 46204
With a cony to:
Chief Legal Counsel/Deputy Commissioner
Indiana Department of Transportation
100 N. Senate Avenue, Room N758
Indianapolis, IN 46204-2216
B. Notices to the State regarding project management shall be sent to respective District
Office:
INDOT -- LaPorte District
PO Box 429
Rage 7 of 9
LaPorte, IN 46352
C. Notices to the Grantee shall be sent to:
City of South Bend
227 W. Jefferson Blvd.
South Bend, IN 46601
16. Order of Precedence.
Any inconsistency or ambiguity in this Grant Agreement shall be resolved by giving precedence in the
following order: (1) requirements imposed by applicable law; (2) this Grant Agreement, (3) exhibits
prepared by the State, (4) Invitation to Apply for Grant; (5) the Grant Application; and (6)any exhibit
prepared by Grantee.
17. Termination for Breach.
A. Failure to complete the Project and expend State, local and/or private funds in accordance with
this Grant Agreement may be considered a material breach, and shall entitle the State to suspend grant
payments, seek recovery or reimbursement of grant payments, and suspend the Grantee's participation in
State grant programs until such time as all material breaches are cured to the State's satisfaction.
B. The expenditure of State funds other than in conformance with the Project or the Budget may
be deemed a breach. The Grantee explicitly covenants that it shall promptly repay to the State all funds not
spent in conformance with this Grant Agreement.
18. Termination for Convenience.
Unless prohibited by a statute or regulation relating to the award of the grant, this Grant Agreement may
be terminated, in whole or in part, by the State whenever, for any reason, the State determines that such
termination is in the best interest of the State. Termination shall be effected by delivery to the Grantee of
a Termination Notice, specifying the extent to which such termination becomes effective. The Grantee
shall be compensated for completion of the Project properly done prior to the effective date of termination.
The State will not be liable for work on the Project performed after the effective date of termination. In no
case shall total payment made to the Grantee exceed the original grant.
The Rest of this Page Intentionally Left Blank.
Page 8 of 9
Non -Collusion, Acceptance
The undersigned attests, subject to the penalties for perjury, that the undersigned is the Grantee, or that the
undersigned is the properly authorized representative, agent, member or officer of the Grantee. Further, to
the undersigned's knowledge, neither the undersigned nor any other member, employee, representative,
agent or officer of the Grantee, directly or indirectly, has entered into or been offered any sum of money or
other consideration for the execution of this Grant other than that which appears upon the face
hereof. Furthermore, if the undersigned has knowledge that a state officer, employee, or special
state appointee, as those terms are defined in Ind. Code § 4-2-6-1, has a financial interest in the Grant,
the Grantee attests to compliance with the disclosure requirements in Ind. Code § 4-2-6-10.5.
In 'Witness 'Whereof, Grantee and the State have, through their duly authorized representatives, entered
into this Grant. The parties, having read and understood the foregoing terms of this Grant, do by their
respective signatures dated below agree to the terms thereof.
Grantee : City of South :Bend, Local unit
By:
Printed Nlame _ °
Title: a r?J? o 6., V K'A,5
Date: //0 °//.:era ''.
The State
Indiana Department of Transpo
Recommended by:
Travis Underhill, Deputy Commissioner
Date:
(fo`r)
Joseph McGuinness, Commissioner
Date:
APPROVED as to form and legality:
Office of the Attorney General
Form approval has been granted by the
Office of the Attorney General pursuant to
IG 4-13-2-14.3(e) on (December 12, 2017
FA 17--66
This Instrument was prepared by:
7
Attested by: �.. A_x � �` o
Printed N4mt ,
Title: ,r. C%.yam A e"._ _r.11
Date: 1.. ...._m
Indiana (Department of Administration
Jessica Robertson, Commissioner
Date:
State Budget Agency
Jason D. Dudich, Director
Date:
Page 9 of 9
(for)
(for)
IN1DOT attorney, on
ATTACHMENT A
PROJECT DESCRIPTION
Des. No.: 1702581.
Program: Local Roads and Bridges Matching Grants
Type of Project:
Road Reconstruction
Location: N. Ironwood Drive from McKinley Avenue to South Bend Avenue
A general scope/description of the Project is as follows: Ironwood from McKinlcy to Corby includes striping
only. Pavement restoration on Ironwood be ins on N side of Corby and extends to S. side of South Bend Avenue.
Curb ramp replacements, striping and new traffic signal equipment.
The maximum amount of state funds allocated to the Project is $ 670,000.00.
Roger Nawrot
From: Blansett, Marcia <MBLANSETT@indot.IN.gov>
Sent: Wednesday, December 20, 2017 2:29 PM
To: Roger Nawrot
Cc: Eric Horvath; Kara (Boyles
Subject RE: 2017 Community Crossings
Attachments: 2017 Local Roads and Bridges Matching Grant South IBend.pcif
Follow Up Flag: Follow up
Flag Status: Flagged
Roger,
Attached you will find the INDGT/I_PA contract for your Community Crossings project.
Please print, obtain signatures (in blue ink) with dates and return 1 original to my attention at the address below
Thaink You,
Marcia Blansett
!PA Program Director � �
PO Box 429 .1
315 East Boyd Boulevard g
LaPorte, IN 46352/4635O
Office: (219) 325-7564
Email: mbl'ansett@indot.in.u;nv
w Indiana
'k
From: (Roger Nawrot[mailto:rnawrot@southbendin.gov]
Sent: Wednesday, December 20, 2017 1.1:54 AM
To: Blansett, Marcia <MIBLANSETT�1a indot.IN.gov>
Cc: Eric Horvath <ehorvath@southbendin.gov>; Kara Boyles <kboyles@southbendin.gov>
Subject: RE: 2017 Community Crossings
**** This is an EXTERNAL email. Exercise caution. DO NOT open attachments or click links from
unknown senders or unexpected email. ****
Marcia -
Attached is the City of South Bend project description.
Thanks -
Roger
From: Blansett, Marcia [mailto:MBLANSETT@indot.IN.gov]
Sent: Wednesday, November 29, 2017 3:55 PM
To: Melinda Kamp; Beverly Shores (Laura Sulivan); beverlyshores.police@gmail.comi; kberger@bourbon in.gov; Alex
Mikel, butz219@comcast. net; rberryman@town,ofbrool<ston.comcastbiz.net; Town of Burlington, Marcus Rogala;
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 12/22/17
Name Roger Nawrot
Department
Division/Bureau
Public Works
Engineering
® Agreement
❑ Contract ❑ Proposal ❑ Addendum
❑ Professional Services
❑ Resolution
❑ Bid Opening
❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet
❑
Quote Opening
❑ Quote Award
❑
Change Order No.
❑
CIO & PCA No. ❑ PCA
❑ Ease/Encroach.
❑
Traffic Control:
ri
Other:
Company or Vendor Name
New Vendor
MBEIWBE Contractor
Indiana
of Transportation
❑ Yes ❑ No L If Yes, Approved by
Purchasing
M11: ■
MBEIWBE Contractor Requested
❑ No ❑j Yes Name of Company
Project Name
2017 Community Crossings Grant
Project Number
117-071
Funding Source
Account No.
Amount
Terms of Contract
Matching up to $670,000
Purpose/Description
This grant is used for the Ironwood Drive Improvements north of
Rockne Drive to SR 23.
Note- Must be signed with blue ink!
❑ Required Contractor's Certification Forms Attaches[ (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Required For Change Orders Only
Amount of ❑ increase
❑ Decrease
$
$
Previous Amount $
Current Percent of Change:
%
New Amount $
Total Percent of Change:
%
Dispersal After Approval
Copy Original
® ❑ Roger Nawrot
❑ ® Marcia Blansett, LPA Program Director, INDOT LaPorte District, PO Box 429,
❑ ❑ 315 East Boyd Bvld., LaPorte, IN 46352/46350