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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 10, 2018 <br />Name Scott Kreeger <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date December 20, 2018 Phone Extension 9245 <br />MIMHHMMMMMMMMmmnrv, wM M rmrcrtr��mm� m w <br />...._ _ .... ......... �...... <br />�.....�._, ... —.. <br />Required Prior to Submittal to Board <br />�.... .........�._ _._........._ _.__ ..... <br />Legal EJ Attorney Name: Clara McDaniels <br />Controller El Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the <br />LJ Agreement Amendment <br />❑ Professional Services <br />❑ Bid Opening <br />Quote Opening <br />E] Change Order No. <br />Ease/Encroach. <br />Other: Reiect or000sals <br />Michael Schmidt <br />Wo�oI .Tr <br />Contract <br />❑ Resolution <br />for All Submissions <br />Proposal <br />(l Bid Award ❑ Req. to Advertise <br />Quote Award <br />C/O & PCA No. ❑ PCA <br />❑ Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Reauilred Information <br />School Zone Flashing Beacon Assemblies <br />117-075 <br />Addendum <br />❑ Title Sheet <br />Terms of Contract <br />Purpose/Description Reject INDOT proposals for federal programforthe assembly of <br />school zone flashing beacons within South Bend, <br />M Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Re wired For Cha�Orders OnIITITITIT�w <br />Amount of ❑ Increase -'$ <br />El Decrease $ <br />