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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />1►"F71ilTai•'�8011-*] <br />Jacob M. Klosinski <br />Department Utilities - Wastewater <br />BPW Date November 13, 2018 Phone Ex <br />tension 574) 235-9496 <br />�.. mm............ ._.._..._....... to B Required Prior to Submittal ... oar--m r" d .......... ......... �._. <br />Legal Attorney Name Clara McDaniels Assistant,City Attorne <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ® and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ® Al Greek Director of Utilities <br />_ Check the Appropriate Item Type — Required All Submissions <br />Agreement <br />Contract <br />yyfor <br />0 Proposal 11Addendum <br />® Professional Services <br />❑ Amendment <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />El Quote Award <br />�] Chg Order No. <br />F] C/O & PCA No. <br />PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control <br />Resolution <br />F] Other: <br />Claim <br />Required Information <br />Company or Vendor Name American Strurepoint, Inc. <br />(Yes If Yes, Approved by Purchasing <br />New Vendor <br />®No <br />❑ MBE El Yes <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ WBE ❑ No <br />Project Name <br />Renewable Fuel Standard Reistration Assistance <br />Project Number <br />118-054 <br />FundingSource <br />Utilities Sewa e Works/Wastewa <br />� ...�n_ � ter, Enqineenng <br />Account No. <br />641-0630-793-31-02 <br />Amount <br />$21,450.00 <br />Terms of Contract <br />_ Hourly, Not to Exceed See Contract for Scope) <br />Purpose/Description <br />_ _ ..... .... <br />American Structurepoint will work with a team of consultants to <br />provide assistance to certify and register the Cit of South Bend <br />Wastewater Treatment Plant for its digester bio as production <br />facility and RINs through the EPA Central Data Exchan e. <br />For Change Orders OnI <br />Amount of ❑ <br />Increase $ �__.... ......... m .. <br />Decrease $ <br />Previous Amount <br />$ <br />