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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /14/19 <br />Name Kyle Silveus Department Enginewern <br />BPW Date 11/26/19 Phone Extension 9083 <br />.Required Prior to Submittal to Board <br />Legal F1 Attorney Name Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Michael Schmidt <br />Check the <br />LJ Agreement <br />Professional Services <br />Bid Opening <br />El Quote Opening <br />�] Change Order No. <br />❑] Ease/Encroach. <br />E] Other: <br />L Contract <br />❑ Resolution <br />® Bid Award <br />l Quote Award <br />[J C/O & PCA No. <br />Traffic Control <br />— rNtlquff fdu ►ur /it/ Ouurr►►ssuu►, <br />..._. . ..... <br />❑ Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />Required Information <br />Company or Vendor Name Northern Indiana Construction Co., Inc. <br />New Vendor <br />❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Historic Leeper Prk Improvements — Bid Packagf <br />Project Number <br />mm..__.a <br />118-010B <br />Funding Source <br />RW TIF Bond �_... ...............___W...ww <br />Account No. <br />452-1101-452-31.02 <br />Amount <br />$ 813,360.05 ������ ......................a <br />Terms of Contract <br />�ww _...............__ ......... <br />Base Bid <br />Purpose/Description <br />K <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verf, Iran, etc. <br />Amount of Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: oho.��..........................�������� <br />Dispersal After Approval <br />Copy Original <br />® ❑ Kyle Silveus <br />mm ""' ......_.......�.................. <br />.._. .__.. <br />® ❑ Patrick Sherman <br />----------- <br />�................. <br />�........... <br />�_.�.�..........�w�w <br />❑ ❑ <br />