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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />February..4.,..20.1_9............._..................._. w __. <br />Jacob M. Klosinski <br />Department Utilities Env. Serv, <br />BPW Date February 12, 201, Phone Extension 574� 235-9496 <br />ww vmu!mmmuw mrmnmeammmwmm, mwn�rsnm umumumumumimumumi uuuuuummmuuuuuuuummmmmmmmmmmmm <br />Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name Clara McDaniels <br />Controller ® <br />Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® <br />*AI Greek Director of Utilities* <br />.. .._ .....__ ... _............ <br />Check the pro ria b Item 7ype — e iced for All Submissions <br />Agreement <br />Contract Proposal Addendum <br />® Professional Services <br />Resolution <br />Bid Opening <br />E Bid Award El Req. to Advertise ❑ Title Sheet <br />Fl <br />Quote Opening <br />❑' Quote Award <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />Ease/Encroach. <br />❑ Traffic Control <br />El Other: <br />Required Information _m <br />Company or Vendor Name <br />Frost Engineering & Consulting <br />New Vendor <br />Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE Fj WBE <br />MBE/WBE Contractor Requested ❑ No Ej Yes Name of Company <br />Project Name <br />North Pum in Station - Flood DamageRepair Plan <br />Project Number <br />.................. w �mmmmmmm.. <br />118-302 <br />Funding Source <br />--.—.............._..._..._.......................... <br />LiabilityInsurance (Building Repairw& Maint. or Insurance Claim) <br />Account No. <br />226-0419-672.36-01 or 226-0419-380.10-83 <br />Amount <br />$ 42,950.00 <br />Terms of Contract <br />Lump Sum, Not to Exceed mmmm <br />Purpose/Description <br />Re nest to a rove- a ProfessionalmmmServices Agreement with Frost <br />Engineering & Consulting to rovide en iineen g plans and <br />s ecificatilons for flood damage repairs at the North Pumping <br />Station. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran„ etc. <br />lie uiredm For ��ta � Orders Only <br />Amount of <br />Increase $�- <br />Decrease $ <br />Previous Amount <br />�._..._........._................................. .. ...wwww dddw ......................... <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: % <br />.�.............__......_.................... <br />Dispersal After Approval <br />Copy Original <br />® F ......KaraBoyles, City Engineer <br />_.'.....5..........................................9....w _w .__....._® El Jacob M. KlosinskiAsistant CityEn.neer .... ...._ <br />-z El Al , Director of Utilities & Susan Zeeb, Director of Financial Services <br />W stew ater <br />