HomeMy WebLinkAboutDeed of Dedication-Public ROW - Cleaning-Up the Right-of-Way at Chippewa Ave. – Civil City of South Bend,OLC53QX
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BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 12/6/2022
Name Leslie Biek, PE Department PW
BPW Date 12/13/2022 Phone Extension 9323
Review and Approval Required Prior to Submittal to Board Diversity Compliance
and Inclusion Officer Officer Name BPW Attorney Attorney Name
Dept. Attorney Attorney Name
Purchasing
Check the Appropriate Item Type – Required for All Submissions
Professional Services Agreement Contract Proposal
Open Market Contract Amendment/Addendum Special Purchase, QPA
Bid Opening Bid Award Req. to Advertise Title Sheet
Quote Opening Quote Award Reject Bids/Quotes
Proposal Opening C/O & PCA No. PCA
Chg. Order, No. Traffic Control Resolution
Other: Right-of-Way
Dedication
Ease./Encroach
Required Information
Company or Vendor Name
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE
WBE Completed E-Verify Form Attached Yes
No
Project Name Chippewa and Michigan Roundabout
Project Number 114-045
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description Cleaning up the r/w at the Chippewa/Michigan Roundabout. The City owns
the r/w but it needs to be dedicated.
For Change Orders Only
Amount of
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Decrease
$
($ )
Previous Amount $
Current Percent of Change:
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%
( %)
New Amount $
Total Percent of Change:
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( %)
Time Extension Amount:
New Completion Date: