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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />December 18, 2017 <br />Jacob M. Klosinski <br />Purchasing <br />Department Utilities Wastewater <br />Check the'Appropriaf tem Type - Required for All';Submissrons i <br />❑ Agreement ❑ Contract ❑ 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. ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />n Other: <br />Company or Vendor Name A&Z Engineering (Fort Wayne,) <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE [] WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Airport Annexation Area - Top ra hic Survey <br />Project Number 117-108 <br />Funding Source TIF River West - Airport and Engineering Professional Services <br />Account No. 324-1050-460-31-02 (TIF) and 101-0608-431-31-06 (Eng) <br />Amount $ 50,000 (TIF) + $3,850 (Eng) = $53,850 <br />Terms of Contract Lump Sum (not to exceed) <br />Purpose/Description The Department of Community Investment and Division of <br />Engineering recommend the approval of a Professional Services <br />Agreement with A&Z Engineerinq for topographic surve in support <br />of planning for services near the Airport Annexation Area at US 20. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of L-i <br />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 />® ❑ Tim Corcoran, Planning Director, Department of Community Investment <br />® ❑ Kara Boyles, City Engineer, Department of Public Works <br />® ❑ Jacob M. Klosinski, Assistant City Engineer, Dept. of Public Works 1 Utilities <br />