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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/1/23 <br />Name Gemma Stanton Department DPW <br />BPW Date 11/14/23 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. 4 Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name INDOT (Contractor is Milestone) <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 Phase IIB <br />Project Number 122-035 <br />Funding Source TIF – River West <br />Account No. 324-444000 <br />Amount $7,381.52 <br />Terms of Contract <br />Purpose/Description Change order #4 for charges incurred during drinking fountain installation <br />_______________________________________________________________ <br />_______________________________________________________________ <br />________________________________ <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ 7,381.52 <br />($ ) <br />Previous Amount $ 3,501,153.99 (previous change orders); $3,450,217.13 (original) <br />Current Percent of Change: <br />Increase <br />Decrease <br />0.214% <br />( %) <br /> New Amount $ 3,508,535.51 <br />Total Percent of Change: <br />Increase <br />Decrease <br />1.690% <br />( %) <br /> Time Extension Amount: <br />New Completion Date: <br />