PSA - Lawson-Fisher - Prepare Bid Docs for Emergency Repair of Chippewa Ave at Bowman Creek

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date September 6, 2016 Name Roger Nawrot Department Engineering BPW Date September 13, 2016 Phone Extension 5932 Required Prior to Submittal to Board Legal ® Attorney Name Michael Schmidt Controller ® Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ® George King Check the Appropriate Item Type - Required for All Submissions ❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum ® Professional Services ❑ Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Change Order No. ❑ C/O & PCA No. ❑ PCA ❑ Ease/Encroach. ❑ Traffic Control 7 Other: Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount !red Information Fisher Associates P.C. U Yes ZI No [-]If Yes, Approved by Purchasing ❑ MBE ❑ WBE ❑ No LJ Yes Name of Company Emergency Repair of Chippewa Avenue at Bowman Creek Major Moves 412.0602.431.42.03 N, C 0AA An Terms of Contract Not to Exceed Purpose/Description To prepare bid documents to repair the pavement and shoulder washout out caused by the August storm.. Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Required For Change Orders Only Amount of ❑ Increase $ ❑ Decrease $ Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: % Dispersal After Approval Copy Original ® ❑ Roger Nawrot ® ❑ DCI - Jitin Kain ❑ ® Lawson - Fisher P.C.