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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/16/19 Department Public Works <br />.... ...........__... ....... <br />Name Kyle Silveus Division/Bureau Engineering <br />............................_ ................. ..... <br />BPW Date 12/19/19 Phone Extension 9083 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name: Clara McDaniels <br />Controller El Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing E] Michael Schmidt <br />Check the ADProeriate Item Tvee — Reaulreo'for All Submissions <br />LJ Agreement <br />F] Professional Services <br />Fj Bid Opening <br />F-1 Quote Opening <br />® Change Order No. 3 <br />❑ Ease/Encroach. <br />El Other: <br />L Contract <br />Resolution <br />❑ Bid Award <br />Quote Award <br />❑C/O &PCANo, <br />Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />I eauired l <br />Indiana Earth, Inc. <br />Proposal <br />Addendum <br />[l Req. to Advertise ❑ Title Sheet <br />❑ PCA <br />rn <br />Western Ave.Streetscape - Phase III <br />IT0.­_......._-..... <br />.. .......... _._................. ............ _ <br />................... <br />RWDA TIF <br />324-1050-460-42-03....................................._�www .....�._.................W <br />$ N/A ...._......................................... <br />Terms of Contract <br />Purpose/Description Add a substantial completiondateto contract and add 27 days, <br />bringing substantial completion to 12/27/19 and the final <br />completion date to 4/21/20. Additional time was needed due to <br />unforeseen conditions, weather, and utility! conflicts. <br />mm ......... <br />I Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />e orders Onf <br />�- <br />Amount of Increase $ 2-7.....................W............__............._w__ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />