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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 17, 2018 <br />Name Kara M. BoylesmmmmmmmWWWWWWWWW <br />Department Engineering <br />Division/Bureau DPW <br />BPW Date 12/20/18 Phone Extension 5933 <br />...vwW._ <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: C. 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 ❑ <br />Check the <br />Agreement <br />Professional Services <br />Bid Opening <br />El Quote Opening <br />F Change Order No. <br />El Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />�ropriate Item Type — <br />[� Contract <br />El Resolution <br />❑j Bid Award <br />El Quote Award <br />El C/O & PCA No, <br />El Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of H Increase <br />(] Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Chane: <br />Copy <br />Original <br />❑ <br />El <br />El <br />for All Submissions <br />Proposal <br />Ej Req. to Advertise <br />I■ • <br />Addendum <br />❑ Title Sheet <br />Required Information <br />Professional Services By and Between the City of South Bend <br />and Jeffrey Weaver <br />El Yes Ej No If Yes, Approved by <br />Purchasing <br />MBE n WBE <br />❑j No Yes Name of Company .................... <br />Professional Engineennc� Servicesmmmmmw .. .. <br />118-117 <br />Professional Services <br />... .....................a.......a. w ..... <br />101-0602-431.31-06 <br />$32 ...__.... _......................................... ..__............_. <br />000 lump sum; $8,400 hourly NTE; Total: $40,400 <br />3 months (January 1-March 31 2019 <br />..._ . i .... .................. <br />mConsultant engineering services relatedtoCIP, Data tools, paving tools, <br />streets tools, etc. Jeff will assists DPW with a transition plan for asset <br />management in 2019. ww <br />Required Contractor's Certification µForms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />uired For Chancre Orders On <br />Disr)ersal After X t)rovaI <br />