Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 31, 2017 <br />Name Roger T. Nawrot <br />. Purchasing <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />LJ Agreement <br />❑ Contract Proposal ❑ Addendum <br />p <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 />Other: Amendment No. 1 <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE 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 " Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />Lawson -Fisher Associates P.C. <br />❑ Yes ® No If Yes, Approved by <br />Purchasing <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Olive Street Reconstruction <br />114-064 <br />LOIT Special Distribution <br />257-0608-431.31-06 <br />$271,000.00 <br />Not to Exceed <br />The Amendment No. 1 is for extending the project limits south to <br />the intersection of Prairie Avenue -SR 23, adding utility <br />coordination, adding the geotechnical investigation and changing <br />the plans to a street typical section of 3 traffic lanes. Original <br />Contract amount is $210,000.00 and the new Total Contract <br />amount is $481,000.00. <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, iran, etc.) <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />