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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 6, 2018 <br />Department Public Works <br />Name Roger Nawrot Division/Bureau Engineering <br />BPW Date, August 14, 2018 Phone Extension 5932 <br />Required Prior to Submittal to Board <br />Legal Attorney Name: <br />Controller ❑ Controller review is required for all Contracts $5,0010.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />21MIMMI onFlol9, <br />F Agreement Amendment <br />F-1 Contract <br />Ll Proposal H Addendum <br />F-1 Professional Services <br />E] Resolution <br />[] Bid Opening <br />El Bid Award <br />❑ Req. to Advertise Title Sheet <br />E] Quote Opening <br />F-1 Quote Award <br />F-1 Change Order No,. <br />F C/O & P,CA No. <br />PCA <br />❑ Ease/Encroach. <br />F-1 Traffic Control: <br />Other: Amendment #1 <br />Required Information <br />Company or Vendor Name <br />Christopher B. Burke Engineering_ <br />LLC <br />F1 Yes M No <br />F] If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEANBE Contractor <br />F MBE [] WBE <br />MBEANBE Contractor Requested No F1 Yes Name of <br />Company ... . ...... <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Mishawaka Avenue Traffic Signals at proposed Fire Station #9 <br />117-120 <br />LRSA-Traffic Signal <br />251-0608-431.36-67 <br />$39,500.00 <br />Not to Exceed <br />Purpose/Description The total adjusted agreement amount is $97,600,00. This <br />amendment is for the design of Fire Station #9 preemption of the <br />traffic signals at the intersections of Mishawaka Avenue with 2 oth <br />Street and Ironwood Drive., The traffic signals will be upgraded <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />F Requirad For Chainge�Q!A <br />Amount of F-1 increase $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change: - % <br />New Amount $ <br />Total Percent of Chan.qe- % <br />Copy <br />Original <br />F-1 <br />El <br />El <br />F-1 <br />El <br />El <br />