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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/19/16 Department Public Works <br />Name Nadia Correa Division/Bureau Engineering <br />BPW Date 09/27/16 Phone Extension 5796 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <br />Controller El greater <br />review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ® Contract ❑ Proposal ❑ Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />n Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanae: <br />Copy <br />Origina <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />Required Information <br />McCormick Engineerina. LLC <br />1' MUM <br />Pu <br />es, Approved by <br />LJ No L_J Yes Name of Company <br />Bowen Street Drainage Improvements <br />116-082 <br />Southside Development Area TIFF <br />430-1050-460-42.03 (12020) <br />,260.00 <br />Subject to RDC approval on Sept 29,2016 <br />Project involves design of a storm line system in order to prevent <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />For Chance Orders On <br />Patrick C. Kerr <br />Eric Horvath <br />Jitin Kain <br />