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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 5, 2018 <br />Department Public Works <br />Name Roger Nawrot Division/Bureau Engineering <br />BPW Date N �_.,............................�....._........��_ <br />ovember 13, 2018 Phone Extension 5932 <br />'�--"AW'91"d+uufJ9mG/;�iIWVIIMdY�'gkY�'��E�' �WdldPkB�ACH/9,f➢O�DYdllfl.'..r. a..v �ui .ems t�.1NW!�"lYr�X"(M�M"�YMY�@W�1 YILZvoa^!Y✓d�lJ9 .... MPo.. .!.'�A'MN�wmv ', SWM»� ��P✓CI�.YD14YYetiA� <br />..Repired Prior to Submittal to Board w <br />Legal ❑ Attorney Name�...�.�.._.��. ..w. <br />Controller ❑ 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 ❑ <br />Check the <br />L Agreement <br />❑' Professional Services <br />[� Bid Opening <br />Quote Opening <br />Change Order No. 3 <br />El Ease/Encroach. <br />F] Other: <br />Company or Vendor Name <br />)roriate Item Type — <br />El Contract <br />❑ Resolution <br />El Bid Award <br />F] Quote Award <br />IBC/O &PCANo. <br />Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />for All Submissions <br />] Proposal <br />❑ Req. to Advertise <br />ired Information <br />❑ PCA <br />Indiana Department of Transportation <br />Addendum <br />❑ Title Sheet <br />LJ Yes H No_M by Purchasin <br />BE .❑ W�w_ BE ��.... If Yes, Approved <br />.._... <br />o of Com any <br />No �J Yes Name � �� ....r... _.�..... <br />SRTS Monroe Primary and Studebaker Elementary R-39513 <br />116-039 <br />Federal 80% and City 20% <br />This change order if for additional excavation and disposal for the <br />removal of tree roots removed under the new sidewalk._ <br />�] Required Contractor's Certification Forms Attached (Non <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />R aired For Char <br />Amount of 0 Decrease $ .. Increase ........$...�....3730.46 <br />El� .......m..m�_....� <br />Previous Amount $ 1,938,001.25 <br />Current Percent of Change: 0.789% <br />New Amount $ 1,,951 ,731.71 <br />Total Percent of Change: 0.708% <br />Dispersal After <br />Copy Original <br />aw <br />❑ ❑ ROe.....rNof <br />....... r <br />Orders On <br />roval <br />