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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />03/19/2018 <br />Kieran Fahev <br />Department LTCP <br />BPW Date 03/27/2018 Phone Extension 5993 <br />I Agreement <br />U Contract LJ Proposal U Addendum <br />® Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Change Order No. <br />❑ <br />CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ <br />Traffic Control <br />n Other: <br />Company or Vendor Name: American Structurepoint <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 <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Green Stormwater Infrastructure Master Plan <br />118-040 <br />Wastewater O&M <br />641-0630-793-63-35 <br />$ 150,000 <br />Citv master Wan to reduce CSO via GSI <br />Purpose/Description LTCP relook has highlighted 9 key CSO basin to be tackled with <br />GSI instead of GreV infrastructure this progresses that effort. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of U 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 />® ❑ Jordan McCormack at American Structurepoint. <br />JMcCormack@structurepoint.com <br />❑ ❑ <br />❑ ❑ <br />