Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 4, 2017 <br />Name Roger Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date December 12, 2017 Phone Extension 5932 <br />U Agreement Amendment <br />U Contract LJ 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 />n Other: <br />Company or Vendor Name <br />Christopher B. Burke Engineering, LLC <br />EI—Yes ® No ❑ If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEIWBE Contractor <br />MBE ❑ WBE <br />MBEIWBE Contractor Requested <br />® No ❑ Yes Name of Company <br />Project Name <br />Mishawaka Avenue Traffic Signals at proposed Fire Station #9 <br />Project Number <br />117-120 <br />Funding Source <br />LRSA-Traffic Signal <br />Account No. <br />251-0608-431.36-67 <br />Amount <br />$58,058.00 <br />Terms of Contract <br />Not to Exceed <br />Purpose/Description <br />Prepare a study of Mishawaka Avenue intersections with <br />Ironwood Drive and 20th Street for the future Fire Station #9 and <br />then start preliminary design for the traffic signal improvements. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders only <br />Amount of ❑ increase <br />$ <br />❑ Decrease <br />$ <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 />