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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/14/19 Department Public Works <br />Name Kyle Silveus Division/Bureau Engineering <br />........ . ... <br />BPW Date 10/22/2019 Phone Extension 9083 <br />Required <br />al to Board <br />Prior to Submittal <br />Legal [Z 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 El Michael Schmidt <br />Check the Appropriate Item Type - Required for All Submissions <br />❑ . . .......... <br />Agreement F1 Contract E] Proposal Addendum" <br />❑ Professional Services [-] Resolution <br />EBid Opening E]Bid Award Req. to Advertise ❑ Title Sheet <br />Quote Opening El Quote Award <br />Change Order No. 3 F-1 C/O & PCA No. ❑ PCA <br />El Ease/Encroach. ❑ Traffic Control: <br />F] Other: <br />Rewired Information <br />Company or Vendor Name <br />Transportation n <br />Indiana@pADue artmet of department ­ . . ­- - <br />New Vendor <br />- - - - - <br />Y , !es Approved by Purc a in <br />MBE/WBE Contractor <br />­�N _fYes, mmmmmmmm <br />MBE F] WBE <br />MBEIWBE Contractor Requested <br />............... <br />No El Yes Name of Co!ppppy <br />... ....... Safe Routes to School near LaSalle Intermediate and Marquette <br />Project Name <br />Prima <br />!imary . . . .......... ....... <br />Project Number <br />ENG: 116-040 DES No: 1600076 <br />Funding Source <br />LOIT Ma or Proiects <br />. . . ......... <br />Account No. <br />257.0608.431.42.96 <br />Amount <br />$1,589,000 <br />Terms of Contract <br />80 /o Federal- 20 o Local <br />Purpose/Description <br />This change order is a balancing change order for reduction in <br />quantities. When this change order is approved, it is to be sent <br />to Scott Randle at American Structurepoint at <br />srandle@structurepoint.com <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Rewired For Chang Orders <br />e rs <br />Amount of El inccease...... . <br />e$64,937.27 <br />Previous Amount $ $1,589,000 <br />. . . .. ........... Current Percent of Change: -4.087% <br />New Amount <br />Total Percent of Change: Di <br />-4.087% <br />. . . . .. .......... ........... ... ...... ...... <br />spersal After Approval <br />Copy <br />Original <br />F-1 Kyle Silveus <br />Caitlin Stevens, MACOG <br />