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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 6, 2017 <br />Name <br />Roger Nawrot <br />Department <br />Engineering <br />BPW Date <br />March 14, 2017 <br />Phone Extension <br />5932 <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 />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: Amendment No. 3 To <br />U Contract <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <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 />1 <br />❑ Req. to Advertise <br />Fisher Associates P.C. <br />I No ❑If <br />WBE <br />Yes Name of Company <br />treet Roundabout at Mich <br />Addendum <br />❑ Title Sheet <br />Street and Main Street <br />Increase Original Contract and Amendment No. 1 & 2 by <br />$10,655.00 to $765,505.00 <br />Not to Exceed <br />Additional Services and to correct a mathematical error in <br />Amendment No. 2 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />❑ <br />er Nawrot <br />— Jitin Kain <br />Lawson — Fisher P.C. <br />