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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/5/2019 <br />y Department Engineering <br />Name K le Silveus w _.... <br />BPW Date 2/12/2019 Phone Extension 9083 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ Michael Schmidt <br />Check the <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. _ <br />Ease/Encroach. <br />Other: <br />iropiriate Item T -- <br />El Contract <br />Resolution <br />[� Bid Award <br />El Quote Award <br />❑ C/O &PCANo. <br />El Traffic Control <br />Reduired <br />Company or Vendor Name Forum Architects, LLC <br />for All Submissions <br />1 Proposal E] Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />on <br />❑ PCA <br />New Vendor <br />❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />O'Brien Recreation Center Renovation <br />Project Number <br />118-091 <br />Funding Source <br />South Side Development Areawww...........Ww_ _ <br />Account No. <br />430-1050-460.42-02 <br />Amount <br />$. ......_. 2,500.00 l._.�.5C-� '......... _ � ......... <br />ar -Iro" ,�2� <br />Terms of Contract <br />Lump Sum <br />Purpose/Description <br />Amendment to PSA for Design Services <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination„ Non -Debarment, E-V�erifv. Iran,. etc. <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />El <br />El <br />❑ <br />11 <br />❑ <br />