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s <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 615118 <br />Agreement <br />Contract H Proposal 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: <br />Company or Vendor Name 00-OUP 'V �JC- <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name _Leeper Park Improvement Project <br />Project Number 118-010 <br />Funding Source RW TIF Bond <br />Account No. 452-1101-452-31.02 <br />sllrem I <br />$ 36,700.00 <br />Terms of Contract Lump Sum <br />Purpose/Description Scoping study and 10% design for Landscape element <br />improvements to Leeper Park <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment, E-Verifv. Iran. etc. <br />Amount of ❑ Increase $ <br />❑ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />