PSA - Donohue & Associates, Inc - WWTP Belt Filter Press No. 4 Rehabilitation Engineering Services

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date January 12, 2017 Name Jacob M. Klosinski Department Utilities Wastewater BPW Date January 24, 2017 Phone Extension (574) 235-9496 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 ® Carol Kurzhal U Agreement LJ 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 Other: ired Information Company or Vendor Name Donohue & Associates. Inc. New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name Wastewater Treatment Plant Belt Filter Press #4 Rehabilitation Project Number Funding Source Utilities, Wastewater Engineering Account No. 641-0630-793-31-02 Amount $ 8,700.00 (Not to Exceed) Terms of Contract Lump Sum & Hourly Services (See Agreement, attached) Purpose/Description Professional Services Agreement with Donohue & Associates to provide Proiect Specifications and Bidding Services for the Wastewater Treatment Plant Belt Filter Press #4 proiect. This is the U Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination Non -Debarment E-Verify, Iran etc Required For Change Orders Oniv Amount of U Increase n Decrease Previous Amount Current Percent of Change: New Amount Total Percent of Change: % Dispersal After Approval Copy Original ® ❑ Al Greek, Director of Utilities ® ❑ Jacob M. Klosinski, Assistant City Engineer ® ❑ Carol Kurzhal, Director of Financial Services, Environmental Services