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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12,/5/2017 Department <br />Name Sue Ellen Doudrick Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 12/12/2017 Phone. Extension 5922 <br />Required Prior to -Libmittal to Board <br />Legal El Attorney Name: Clara McDaniels <br />Controller El 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 El <br />Agreement Amendment <br />Professional Services <br />❑ Bid Opening <br />Quote Opening <br />F1 Change Order No. <br />Ease/Encroach. <br />❑ Other: General Release <br />Company or Vendor Name <br />LJ Contract <br />F-11 Resolution <br />El Bid Award <br />El Quote Award <br />El C/O & PCA No <br />F1 Traffic Control-, <br />New Vendor <br />MBENVBE Contractor <br />MBE/WBE 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 />SmithGroupJJR, Inc. <br />arSTOTIM, <br />[] Req. to Advertise <br />SIM <br />E]Title Sheet <br />0 Yes El No El If Yes, Approved by <br />Purchasing <br />[:] MBE F-1 WBE <br />[I No Ell Yes Name of Compan <br />Seitz Park Reconstruction <br />11 7-093 <br />Park Bond & TIF Bond <br />$186,400 (50% from Park Bond, 50% from TIF Bond) <br />Schematic design for Seitz Park, Colfax Ave, pedestrian <br />crossing, East Race Pedestrian Crossing, East Bank trail, Seitz <br />and Howard Park connection, Seitz and West Bank Trail <br />Connection <br />L] Required contractor's Certification Forms Attached (Non - <br />Collusion, N on-Discril rn i nation, 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 />F-1 <br />F-1 <br />F-1 <br />M <br />El <br />1-1 <br />