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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 15 2019 <br />Department Public <br />Name Scott Kreeger Works <br />BPW Date Aril 23 2019 Phone Extension 9245 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ® <br />Michael Scbmid,t <br />Check the A <br />ro riat Item e " <br />F] <br />Professional Services Agreement <br />Contract <br />n <br />Open Market Contract <br />❑ Amendment/Addendum <br />01 <br />Bid Opening <br />❑ Bid Award <br />FJ <br />Quote Opening <br />® <br />Quote Award <br />❑ <br />Proposal Opening <br />F-I <br />C/O & PCA No. <br />❑ <br />Chg. Order, No. <br />[:] <br />Traffic Control <br />F-1 Other: <br />Required Information <br />�r A <br />c <br />❑ Proposal <br />❑ Special Purchase, QPA <br />E] Req. to Advertise <br />E] Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />Northern Indiana Construction <br />_ <br />Yes[:] If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />❑❑ <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached Nos <br />Project Name <br />East Bank Sinkhole Repairs _uu uuu __..._.__ .. <br />Project Number <br />118-305A <br />Funding Source <br />_. Streets and Alleys <br />Account No. <br />_ ............................ ............... <br />226.0419.672.42.03 <br />Amount <br />_........................ .............. ._.___................ <br />$68,728.00 <br />Terms of Contract <br />Base Quote + Alternate 2 <br />Purpose/Description <br />epalr the East Bank sinkhole along Lasalle Avenue. <br />Amount of <br />Previous Amount <br />❑ Increase <br />❑ Decrease <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase % <br />Decrease Q' % <br />Increase % <br />.._.................... <br />Decrease ( /o <br />