Access Permit for AEP - ORC Utility & Infrastructure Land Services LLC - Access Segments of East Bank Trail

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date December 17, 2018 Name Becca Plantz W ....._.. Department Public Works Division/Bureau Engine ering BPW Date December 20, 2018 Phone Extension 5998 or to Submittal to Board Legal EJ Attorney Name: Clara McDaniels Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing El _. Check the Agreement Amendment Professional Services Bid Opening ] Quote Opening E' Change Order No. Ease/Encroach. Other: Access Permit ►rr a Item:e...- E Contract Resolution ❑ Bid Award ❑ Quote Award El C/O & PCA No. ❑ Traffic Control: _ Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description for All Submissions FP ❑ Req. to Advertise ❑ PCA Addendum ❑ Title Sheet Re_. u�ired Information AEP ......... 0❑ _, .. w Yes No �] If Yes Approved to b Purchasin V� MBE WBE ,....___ Comp _. o Yes Name of C _..�..,,,,mwe�...._..�.........�aw.� Indiana Michigan Power I & Mj Access Permit Request Indiana Michigan Power is requesting to access segments of the East Bank Trail for a soil boring to survey for a proposed electric transmission line route. Ll ................................ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) e ._..__ ._. Increase $ Eqq For Chaq . e El Amount of _ �...._�.�� _... _ .,_ .... _......... �. ... Ej Decrease $ Previous Amount $ Current Percent of Change; % New Amount Total Percent of Change: Diisoersal After Copy Original ® ❑ Becca Plantz ❑ ...n F] —..........._............. El