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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 27, 2018 Department Public Works <br />.._........ . _ .. ...... ........ . __.............__.... <br />Name Alicia Czarnecki/Patrick Sherman Division/Bureau Engineering <br />BPW Date January 8, 2018 Phone Extension 5903 <br />quired Prior to Submittal to Board <br />Legal® 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 <br />Check the <br />Agreement Amendment <br />❑ Professional Services <br />F-1 Bid Opening <br />Quote Opening <br />F1 Change Order No. <br />0 Ease/Encroach. <br />Other: <br />)ropriate Item Type — Required for All Submissions <br />Contract Proposal <br />Resolution <br />El Bid Award ❑ Req. to Advertise <br />El Quote Award <br />❑ C/O & PCA No, ❑ PCA <br />❑ Traffic Control: <br />Required Information <br />Addendum <br />❑ Title Sheet <br />Company or Vendor Name DLZ <br />El Yes Z No ❑ If Yes, Approved by <br />New Vendor Purchasing <br />.__.. � ��......... ........ ..........__... <br />MBE/WBE Contractor TMBE WBE .�.......�� <br />... <br />MBE/WBE Contractor Requested No Yes Name of Corn n <br />Project Name Pinhook Park Improvements Project <br />..�.. ......... <br />._....__.. <br />Project Number 118-077 <br />Funding Source Park Bond Series H <br />Account No. 471-1136-452.31.02................_-.... �� __..........__. <br />Amount Amendment 1: $4,050.00 New Contract Amount: $65, <br />Terms of Contract Lump Sum for design services; Not to Exceed <br />Purpose/Description Amendment 1 for the Additional Services of Archaeological Investigation as <br />requested the INITSHIPO for Section 106 coordination. ..... ........_.. ._. <br />❑ Required Contractors Certification Forms Attached Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />_...... wired For Charge Orders Only _ <br />Amount of Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: ._._.....% <br />New Amount $ ............_._ <br />Total Percent of Change: <br />......... <br />Dispersal After A removal__ <br />Copy Original ____..... <br />® ❑ Scott Kreeger, Project Engineer <br />® 0 Kara Boyles, City Engineer, PE ................................ .w............ <br />. <br />® ❑] Patrick Sherman, VPA Project Manager <br />