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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/7/2020 <br />Name Leslie Biek, PE Department PW <br />BPW Date 12/17/2020 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ Officer Name Larry King <br />and Inclusion Officer <br />BPW Attorney <br />® Attorney Name <br />Dept. Attorney ® Attorney Name <br />Purchasing ® Ron O'Connor <br />Check the Appropriate Item 'I <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />I-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Clara McDaniels <br />Clara McDaniels <br />— Reauired for All Submissions <br />❑ Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />Jones Petrie Rafinski <br />U Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />Yes U If Yes, Approved by Purchasing <br />❑ Title Sheet <br />® No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Signal Detection Improvements <br />120-046 <br />2020 Signal Funding <br />251-06-600-506-436010 <br />$33,610 <br />Terms of Contract Development of Construction Documents <br />Purpose/Description Improvements to existing traffic signals at seven (7) intersections maintained <br />by the City. Some intersections are jointly owned with Mishawaka. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Increase <br />Decrease <br />Increase <br />Decrease <br />New Completion Date: <br />