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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 29, 2018 <br />Department Engineering <br />Name Kara M. Boyles <br />Division/Bureau DPW <br />BP,W Date 6/12/18 <br />Phone Extension 59�33 <br />. . . ...... <br />Reqwire d'Prior to Submittal to Board <br />Legal Z <br />Attorney Name: C. McDaniels <br />Controller ❑ <br />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 ❑ <br />Check the Appropriate horn Type — Required for All Submissions <br />Z Agreement <br />F-1 Contract F-1 Proposal ❑ Addendum <br />M Professional Services <br />F-1 Resolution <br />F-1 Bid Opening <br />F Bid Award F] Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />F1 Quote Award <br />Change Order No. <br />F1 C/O & PCA No., El PCA <br />❑ Ease/Encroach, <br />❑ Traffic Control: <br />F1 Other: <br />Required Info rm'affo n <br />Company or Vendor Name <br />Lawson Fisher Associates <br />0 Yes E] No [:1 If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBENVBE Contractor <br />_[jMBE [:] WBE <br />MBE/BE Contractor Requested [J No [J Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />2018 FDR - South Bend Sewer Study <br />118-304 <br />Liability Insurance <br />226-0419-672,.42-03 <br />HNTE $50,000 <br />N/A <br />Purpose/Description Sewer system investigation of areas that experienced significant <br />flooding during the 2018 February Flood of Record event. <br />0 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required or <br />Amount of El increase $ <br />[:] Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />E] <br />n <br />n <br />n <br />E] <br />