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Date <br />Name <br />BPW Date <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />04/04/2017 <br />Kieran Fahey Department LTCP-Engineering <br />04/11/2017 Phone Extension 5993 <br />�Reg uire 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 <br />U Agreement <br />U Contract U Proposal U Addendum <br />® Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />F-1 Other: <br />Company or Vendor Name: Stantec (MWH, the LTCP contractors, are now officially known as <br />Stantec) <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name LTCP retook Phase 2 Master <br />Project Number 117-056 <br />Funding Source Wastewater <br />Account No. 641-0630-793-31-02 <br />reement <br />Amount $ 0 <br />Terms of Contract <br />Purpose/Description To have the Board approve the Master Agreement that will be used <br />in the next phase of LTCP relook. As required, Task Orders will <br />follow. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment, E-Verifv. Iran, etc.) <br />Amount of ❑ increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />