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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 4, 2019 Department Public Works <br />......... <br />................_........_._ <br />Name Kyle Silve._us Division/Bureau Engineering <br />_ .............. _ ...... <br />..__ <br />BPW Date February 12, 2019 Phone Extension 9083 <br />IT _ Required Prior to Submittal to Board <br />Legal <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 ❑ Michael Schmidt <br />Check the A ro riate Item Types Required for All Submissions <br />Agreement Contract Proposal <br />Professional Services Resolution <br />Bid Opening Bid Award ❑ Req. to Advertise <br />Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />EJ Ease/Encroach. ❑ Traffic Control: <br />E Other: <br />Required Information <br />Company or Vendor Name <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 />United Consulting <br />Yes No ❑ If Yes, <br />�] MBE H WBE <br />o 0 Yes Name Of Cormpan)r — <br />Coal Line Trail Phase 2 <br />EKG 115-064 DES No: 1401811 <br />Riverwest TIF <br />�...... .- ..... <br />._. �....... <br />324.1050.460.42.02 <br />$87,370 <br />Addendum <br />❑ Title Sheet <br />Purchasi <br />Total fee not to exceed. (Contract funds are conditional to <br />budget approval by Redeyelo mM ent Commission on 2/1w .) <br />Scope includes: Right of Way Services _ <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />........ Required For Chary Orders On <br />Amount of Increase $ <br />Decrease $ <br />......_ . <br />Previous Amount <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change % <br />Dispersal After Approval <br />Copy Original <br />® ❑ Kyle Silveus <br />® D Chris Dressel <br />