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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date -September 17 2019 <br />Name Chris Dressel Department DCI <br />. . <br />BPW Date Phone Extension 5847 <br />ua......minunininiwWMIMMEeowxfl �w­Z'Ng M%�'_ <br />....��_.._._� __ ��.............�w.� � �... ...... �. .,,,,,. ..._.. ��._ .l(�qu�rocPrior or to Submittal to Board <br />......... ��� . � � .� Y..... <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney Attorney Name Sandi Kennedy <br />_..... ..... <br />Purchasing ❑l <br />Check the <br />Professional Services Agreement <br />Open Market Contract <br />❑ Bid Opening <br />Quote Opening <br />Proposal Opening <br />❑ Chg. Order, No. <br />E] 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 />pi'o )ri to Item TT <br />Contract <br />?uired,Jr All Submissions <br />E] Amendment/Addendum <br />Bid Award <br />EJ Quote Award <br />Q' C/O & PCA No. <br />Traffic Control <br />Required Information <br />Proposal <br />LJ Special Purchase, QPA <br />Req. to Advertise ❑ Title She( <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />Indiana .. Indiana ..fields Program <br />E] Yes] If Yes, �Appro Approved f <br />No <br />MBE [� WBE Completed E-Verify Form Attached Ej Nos <br />Environmental Project Financial Assistance Agreement <br />F <br />--�� ementa E � ,1 ww m ........ � .. <br />Environmental assessment cleanup and remediation of property at 534 <br />Laporte through funds granted by Indiana Brownfields Program / Indiana <br />Finance Authority <br />For Change Orders . .. ._.........-------- <br />Only <br />AIncrease $ <br />Amount of <br />�....... ... --------------- <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase <br />/o <br />Current Percent of Change: <br />Decrease <br />% <br />New Amount <br />$ .........................�............................_� <br />Increase....W <br />%.... <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />