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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />August 1, 2017 <br />Jacob M. Kiosinski <br />Department Utilities Env. Serv. <br />BPW Date August 11, 2017 Phone Extension (574) 235-9496 <br />Vne.0 the Hp ropriate;item ype;- Kequirea;rorlin oupmissions <br />❑ Agreement ❑ Contract Ll 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 />r_1 Other: <br />Company or Vendor Name Arcadis U.S. <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEANBE Contractor ❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name WWTP - Headworks Influent Gates Improvements <br />Project Number 117-026 <br />Funding Source Utilities - Wastewater - Engineering <br />Account No. 641-0630-793-31-02 <br />Amount $ 105,720.00 <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ <br />El <br />Not to Exceed <br />The Division of Utilities recommends the a roval of a Professional <br />Services Agreement with Arcadis U.S. for the design and <br />construction administration services for the Wastewater Treatment <br />Plant Headworks Influent Gates Improvements promect. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <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 />® <br />❑ <br />% <br />Dispersal After Approval <br />Al Greek, Director of Utilities <br />Jacob Klosinski, Assistant City Engineer <br />Carol Kurzhal, Director of Financial Services, Environmental Services <br />