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f <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REQUEST FORM <br />Please Submit Agenda Item in Signed, Original Format <br />Please Complete All Applicable Sections of Form <br />Date: 12/21/05 <br />From: Jason J. Durr, P.E. <br />Department: Engineering <br />Phone: 235-5998 <br />Type of Agenda Item (drop down list): Contract/Agreement <br />For Board of Works Meeting: 12/27/05 <br />Contractor/Consultant Name: Anchor South Bend LLC <br />Project Name Ireland Road Improvements <br />Project Number <br />Purpose/Description: <br />Amount of Contract/Agreement: <br />• Funding Source <br />Change Orders - Increase/Decrease: (please <br />check one) <br />• Amount of ❑Increase ❑Decrease: <br />• Total Percent of Increase/Decrease: <br />• Original Contract/Project Amount: <br />• New Contract/Project Amount: <br />• Funding Source: <br />Sign Right of Way dedication <br />of the widening of Ireland <br />Road (See Exhibit A) <br />$ 0.00 <br />❑ Increase ❑ Decrease <br />Note: For Questions, Please Contact Board of Public Works at 235-9253 <br />