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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 6, 2017 <br />Name Roger Nawrot Department Engineering <br />BPW Date March 14, 2017 Phone Extension 5932 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ❑ Controller 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 Ll 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 />® Other: Amended Agreement No. 3 <br />Required Information <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 />Lawson -Fisher Associates P.0 <br />❑ Yes ® No <br />Purchasing <br />U No U Yes Name of Company <br />Chippewa Avenue at Michigan and Main Streets <br />114-045 <br />SSDA TIF <br />430-1050-460-31.06 <br />Increase Original Contract and Amendment No. 1 & 2 by <br />$2r570.00 to $646,870.00 <br />Terms of Contract Not to Exceed <br />Purpose/Description Additional Services and to correct a mathematical error in <br />Amended Agreement No. 2. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />Jitin Kain <br />Nawrot <br />