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Date <br />Name <br />02-20-2017 <br />Kevin Fink <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 02-28-2017 Phone Extension 5903 <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 <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 />F� Other: Contract Amendment <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 Chanqe: <br />Copy Original <br />❑ ❑ <br />Information <br />Abonmarche Consultants, Inc <br />❑ Yes No ❑ If ` <br />LJ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company _ <br />Safe Routes to School near Monroe <br />Studebaker Elementary School <br />ENG: 116-039 DES No: 1600075 <br />251.0608.380.10.99 <br />$21,800 <br />and <br />Not to exceed <br />Additional Preliminary Engineering (PE) Services; Eligible for <br />80/20 Federal Split <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />For <br />C <br />