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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/18/2018 <br />Name Sue Ellen Doudrick <br />Department BPW <br />Division/Bureau Engineering <br />BPW Date 12/20/2018 Phone Extension 5922 <br />nuw�a�rm�inmm�urrro�nnm�miourv����m�om�imi�im��Momomimm�o���imim uiuiuiuiuiuyiyiwam.�.w�m ar. uaw��ww.uwwav�r,�mimrv�.... vamm^m�,uwu <br />required Prior to Submittal to Board <br />Legal ❑ Attorney Name: Clara McDaniels _........_....... <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 El <br />Ty q 1 Submissions <br />Agreement Amendmen e Appropriate <br />.............. m Pro _... wwww <br />Check t Item T e Re u�red for All <br />t ❑Contract posal ❑Addendum <br />El Professional Services ❑ Resolution <br />Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑, Quote Opening Quote Award <br />El Change Order No. ❑ C/O & PCA No. ❑ PCA <br />El Ease/Encroach. Traffic Control: <br />Other: <br />Required Information <br />Company or Vendor Name <br />Earth <br />_Indiana . <br />❑ Yes ®No.��,,,,,..,,..,.._ ... .. ❑..�.�.. <br />If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBE/WBE Contractor <br />[❑I <br />MBE <br />[:1 WBE <br />MBE/WBE Contractor Requested <br />q <br />0-No <br />„mm�mmYes <br />,Name ofCompany <br />Project Name <br />"Three Twenty Cascades" — Site Utilities <br />Project Number <br />118-074 D <br />FundingSource <br />_ <br />River East TIF �.�..........................................._........�.�...w�.. �,�.................................��...._.m.....................� <br />Account No. <br />429 <br />Amount <br />....A....&�C...m��_._........_��.�.................�....—._ <br />$168,472.00(Divisions <br />Terms of Contract <br />Unit prices <br />Purpose/Description <br />Site Utilities (water, sewer, storm)for the Cascades <br />development at 320 E. Colfax <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />_...... __Be q 9 1 red For Chan ie Orders Only <br />Amount of Increase $ <br />[l Decrease <br />