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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: <br />Name <br />08/26/2020 <br />Finnian Cavanauszh Department of Public Works — Engineering Division <br />BPW Date: 09/08/2020 Phone Extension: 5961 or fcavanau@southbendin.gov <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Abbrobriate Item Tvlle — <br />All Submissions <br />U Professional Services Agreement U Contract U Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />® Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Information <br />Company or Vendor Name <br />TBD <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MB❑ Yes <br />MBE/WBE Contractor <br />E Completed E-Verify Form Attached ❑ <br />❑ No <br />Project Name <br />Triumph Court Lighting Addition <br />Project Number <br />120-006E <br />Funding Source <br />Light Up South Bend <br />Account No. <br />404-06-600-500-422018-06LUSB- <br />Amount <br />TBD <br />Terms of Contract <br />NTE <br />Purpose/Description <br />Scope of work to include installation of four new streetlights on Burns Ave. <br />and Duey St. near Napoleon St. Work shall include extension of the existing <br />lighting circuit with new conduit and wiring. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />