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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/17/2018 <br />Name Kieran Fahey Department Engineerin <br />® <br />Agreement ❑ Contract U Proposal U Addendum <br />® <br />Professional Services ❑ Resolution <br />❑ <br />Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening ❑ Quote Award <br />❑ <br />Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. ❑ Traffic Control <br />I —I <br />Other: <br />Company or Vendor Name: Stantec Consulting Services Inc <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name LTCP Renegotiation support Task Order 4 <br />Project Number 117-056.4 <br />Funding Source Wastewater Professional Services Engineering <br />Account No. 641-0630-793.31-02 <br />Amount $ 188,920 <br />Terms of Contract A task order based on a previously approved Master Agreement which <br />was reviewed by legal and purchasing and approved by BPW <br />Purpose/Description Preparation for Regulatory meetings and other LTCP tasks <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, , Iran, etc.) <br />Required For Chan" e Orders Onl <br />Amount of ❑ 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 />❑ ❑ <br />❑ ❑ <br />