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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 16, 2018 Department Public Works <br />Name Alicia Czarnecki/Sue Ellen Doudrick .....__ Division/Bureau Engineering_......._..w.... <br />BPW Date November 27, 2018 Phone Extension 5903 <br />P[HPMPNNMIIMMmmmmm mimic <br />.....�.... ... .. ............ .. ....._ <br />Required Prior to Submittal to Board._ . <br />_ ... <br />Legal__.._ Le y <br />g Attorney Name: Clara McDaniels <br />Controller 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 El <br />Check the <br />Agreement Amendment <br />Professional Services <br />El Bid Opening <br />F Quote Opening <br />El Change Order No. <br />Ease/Encroach. <br />Other: <br />iropriate Item Type — <br />I❑ Contract <br />Resolution <br />E] Bid Award <br />Quote Award <br />C/O &PCANo. <br />_ <br />❑ Traffic Control: <br />for All Submissions <br />] Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Required Information <br />Company or Vendor Name Cardno, Inc. <br />❑� If �pp.�.................��� ........... <br />Yes No Yes, oved by <br />New Vendor Purchasina <br />MBE/WBE Contractor H MBE _ WBE <br />MBE/WBE Contractor Requested � q ❑ No w Yes Name of Cornanr <br />Project Name St. Joseph Riverbank Stabilization <br />Project Number 118-043 <br />Funding Source Utility Expense /Contractual Service Fundmmmmmm.................. <br />Account No. 251.0608.431.42 96 LRSA <br />Amount $40,000.00 � ��� ......... �.._.�_..._ <br />Purpose/Description se/De Contract <br />ton Perform a feasibility t study of the west bank of - � <br />p _ d <br />P p y y the St. Joseph <br />�._.... <br />aver a ong Riverside Drive at the Yukon Street intersection, <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />euired For ChaOrders Only <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: ................% <br />New Amount $��� <br />Total Percent of Change: % <br />_............ mm. _...._ <br />...... <br />D'is ersal After Approval _._... <br />Copy Or�iginal .... ... ........ <br />ww �...._..�_�..� <br />® ❑ Alicia Czarnecki, Project Engineer <br />® ❑ Kara Boyles, City Engineer, PE................._.������....�....................... �� .............ww............... <br />® ❑ PatrickSherman VPA� Project Manage ........................................._. �.............������..... <br />