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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 18, 2018 <br />Name Roger Nawrot Department Engineering <br />BPW Date April 24, 2018 Phone Extension 5932 <br />H 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 />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />I� Other: Amendment No. 1 <br />Company or Vendor Name <br />Lawson -Fisher Associates P.C. <br />❑ Yes ® No ❑j If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Corby Blvd. -Ironwood Dr.-Rockne Dr, <br />Project Number <br />116-034 <br />Funding Source <br />LOIT Special Distribution <br />Account No. <br />257-0602-431.42-96 <br />Amount <br />$ 24,200.00 <br />Terms of Contract <br />NTE <br />Purpose/Description <br />Existing Agreement is for $468,625.00 the Total Amount of the <br />revised Agreement is 492 825.00. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />❑j 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 />