Professional Services Agreement - DLZ Indiana LLC - Design Services for Washington and LaPorte St Intersection

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Name 11/19/18 Chris Dressel Department Community Investment BPW Date 11/27/18 Phone Extension 5847 i � �� a�w�muuhwium�rmu�;wu�®mmn�mmmmmns�urmuumv��oimmmw �wmmm��w�ums�wi�¢imonre�rvuw�r�u�ur�w��e�r�mmwo� ammm��mmr�u�uuuuraraaaw�� R umiredmmmPrior to Submittal to Board Legal Z Attorney Name Sandra Kennedy Controller z Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing D Check ..-" -.- ._...... -�� Agreement ® Professional Services ❑ Bid Opening ❑ Quote Opening ❑ Change Order No. _ 0 Ease/Encroach. F-1 Other: HE1M H Contract 0 Resolution F] Bid Award ❑ Quote Award C/O & PCA No. ❑ Traffic Control for All Submissions Proposal— ❑ Req. to Advertise ired Information Company or Vendor Name DLZ Indiana LLC ❑ PCA New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name Washinc ton/LaPorte Improvement Pro..ect Project Number 118-105 ❑ Title Sheet Funding Source COIT Account No. 404-1001-460-42.03 Amount $ 43,000 Termsof Contract 11 /27/18�_ 12/3l./�.........................��.............................. � � � �......m..m..m..m..m..m..m..m.......................� �� . .....�.,......,,._,,, ........... ......................... _,,,............ Purpose/Description Assist City of South Bend with design services for improvements to the Washington Street / LaPorte Street Intersection ❑ Required Contractor's Certification Form Attached (Non - Collusion Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) Ike uired For Change Orders On Amount of Increase Decrease $ Previous Amount Current Percent of Change: New Amount Total Percent of Change: - Dispersal After Approval Copy Original ❑ El ❑ El