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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 3, 2018 <br />Name Roger Nawrot Department Public Works <br />BPW Date April 10, 2018 Phone Extension 5932 <br />H Agreement <br />[I Contract U Proposal LJ Addendum <br />® Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />71 Other: Amendment No. 2 <br />Company or Vendor Name American Structurepoint, Inc. <br />New Vendor ❑ Yes ® No E] If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE E] WBE <br />MBEIWBE Contractor <br />Requested ❑ No ❑ Yes Name of Company <br />Additional South Bend Downtown Road, Traffic and Signal <br />Project Name Improvements Work <br />Project Number 115-019 <br />Funding Source TIF Bond <br />Account No. <br />Amount No Change <br />Terms of Contract Not to Exceed <br />Purpose/Description For Appraising and Purchasing two parcels of right of way on the <br />south side of Sample Street west of Main Street. <br />X Required Contractor's Certification Form Attached (Non -Collusion, <br />Non -Discrimination, Non -Debarment, E-Verifv. Iran, etc.) <br />Amount of <br />Previous Amount <br />❑ Increase $ <br />❑ Decrease $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ Roger Nawrot <br />❑ ❑ Jitin Kain <br />❑ ❑ <br />