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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 4, 2019 <br />............ ..... -.......... <br />_ <br />Name Kyle Silveus <br />Department Public Works <br />............ <br />Division/Bureau Engineering <br />BPW Date February 12, 2019 Phone Extension 9083 <br />... <br />Required Prior to Submittal to Board <br />Legal Attorney Name: Clara McDaniels <br />Controller D 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 E] Michael Schmidt <br />Check the <br />HI Agreement <br />[l Professional Services <br />El Bid Opening <br />F] Quote Opening <br />❑ Change Order No. <br />Ease/Encroach. <br />] Other: Contract Succlement <br />hrolpriate Item Type <br />Contract <br />Resolution <br />El Bid Award <br />Quote Award <br />C/O &PCANo. <br />❑ Traffic Control: <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 />Amount of H Increase <br />0 Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Chane: _.. <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />❑ <br />El <br />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />ired Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />United Consulting <br />El Yes 0 No El If Yes, A roved by Purchasing m <br />MBE WBE ........WWu <br />No ❑ Yes Name of Comfy <br />_... <br />Coal Line Trail Phase 2 <br />ENG: 115-064 DES No: 1401811 <br />__...u__ _._._ <br />Riverwest �Tl F ......_�.... <br />................... <br />324.1050.460.42.02 <br />�_..........._. ............ ............................................... . . . .......... .- ...................... .... <br />PhaseW Increase of $5,640 <br />Total fee not to exceed ..... .. <br />Scope additions include: Appraisal Problem Analysis (APA) <br />costs <br />RequiredWContractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Kyle Silveus <br />Chris Dressel <br />uired For ChangeOrdersO <br />Dispersal After Aeeroval <br />