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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 6, 2018 <br />Name Roger Nawrot <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date August 14, 2018 Phone Extension 5932 <br />Rpn uired Prior to Submittal to Board <br />Legal 01 Attorney Name. - <br />Controller F-1 Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />U Agreement <br />El Professional Services <br />F-1 Bid Opening <br />❑ Quote Opening <br />Change Order No. 2 <br />El Ease/Encroach. <br />F1 Other: <br />Company or Vendor Name <br />LJ Contract <br />El Resolution <br />F1 Bid Award' <br />F] Quote Award <br />F1 C/O & PCA No. <br />F1 Traffic Control: <br />New Vendor <br />MBEN\1BE Contractor <br />MBEN\1BE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Proposal <br />El Req. to Advertise <br />Elm <br />I <br />Indiana Department of Transportation <br />Addendum <br />❑ Title Sheet <br />10 No If Yes, Approved by Purchasina <br />IN M _BE 9 ­­WB E <br />LJ No LJ Yes Name of CoMpapy <br />SRTS Monroe Primary and Studebaker Elementary R-39513 <br />116-039 <br />Terms of Contract Federal 80% and City 20O/o <br />Purpose/Description This change order if for additional excavation and disposal for the <br />-removal of tree roots removed under the new sidewalk. <br />Ll Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Rc�uird For Chan Orders �r�ly <br />Previous Amount $ 1,925,451.75 <br />Current Percent of Change: 0.567% <br />New Amount $1,936,441,791 <br />Total Percent of <br />Di s ersal After A royal <br />Copy Original <br />F] F-1 <br />R El <br />