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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br /> <br />Date 10/9/23 <br />Name Gemma Stanton Department PW <br />BPW Date 10/24/23 Phone Extension 9083 <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br /> <br />Purchasing <br />Check the Appropriate Item Type – Required for All Submissions <br /> Professional Services Agreement Contract 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. 16 and Final Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name INDOT (Contractor is Selge) <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor MBE <br /> WBE Completed E-Verify Form Attached Yes <br /> No <br />Project Name Coal Line Trail Ph 1 <br />Project Number 115-063, PROJ 18, DES#1401810 <br />Funding Source 324-444000 <br />Account No. PO-25244 <br />Amount $21,087.15 <br />Terms of Contract <br />Purpose/Description Final balancing change order. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$21,087.15 (20% of $105,435.72) <br />($ ) <br />Previous Amount $1,871,262.79 <br />Current Percent of Change: <br />Increase <br />Decrease <br />6.494% <br />( %) <br /> New Amount $1,976,698.51 <br />Total Percent of Change: <br />Increase <br />Decrease <br />15.247% <br />( %) <br /> Time Extension Amount: <br />New Completion Date: <br />