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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />March 6th, 2017 <br />Department <br />Public Works <br />Name <br />Kevin Fink <br />Division/Bureau <br />Engineering <br />BPW Date <br />March 14th, 2017 <br />Phone Extension <br />5903 <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 <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 />IRI Other: Contract SuDDlement <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBEANBE 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 Change: <br />Copy <br />Origin <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Information <br />United Consulting <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Coal Line Trail Phase I <br />Coal Line Trail Phase II <br />ENG: 115-063 DES No: 1401810 <br />ENG: 115-064 DES No: 1401811 <br />Riverwest TIF <br />324.1050.460.42.02 <br />Phase I: Increase of $192,400 <br />Phase II: Increase of $185,900 <br />Total fee not to exceed <br />Scope additions include: RoW Engineering, Landscape <br />Architecture, and added trail design components <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />or <br />