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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/03/19 Department Public Works <br />Name Kyle Silveus Division/Bureau Engineering <br />BPW Date _9/10/19 �_�.�.�..����_....��. m�......�...........� _...........�.... Phone Extension ......... <br />90.... <br />...... <br />_......................�_,...........�,,.,�..............��... <br />83 <br />u ,... e�rwrwmm000�mm�r�murvrvrviuiu mmumuwwwwwwwwwwwwuuuwu�nromn�rmr,�r�r enev „... imimumimmmuuuuuuuuuumam,��m <br />... ... .�m...w... .. Rquured 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 Michael Schmidt <br />�f Agreement ----or All Submissions <br />Check the Appropriate Contract � .. � Requited ,Proposal ❑Addendum <br />Professional Services Resolution <br />[❑ Bid Opening EJ Bid Award Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />® Change Order No. 1 ❑ C/O & PCA No. ❑ PCA <br />Ease/Encroach. ❑ Traffic Control: <br />�❑ Other: <br />Required Information <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 />Terms of Contract <br />Purpose/Description <br />Copy <br />Original <br />El <br />El <br />Indiana Earth, Inc. <br />Western Ave. Streetscape - Phase .III ............................... a �.�..................�������............. <br />118-076 <br />......... <br />RWDA TIF, Storm <br />....Water Fund <br />324-1050-460-42-03„ 667-0621-792-42-04 <br />.._..........�........................... ��............................�................. ------ _ <br />of C.O. #1 <br />