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14 <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 6, 2011 Department C &ED <br />BPW Date December 22, 2011 Phone 235 -5842 <br />Name Bill Schalliol <br />o Legal ® Attorney Name L. Meteiver <br />0— -0 Controller review is required for all Contracts $5,000.00 or more <br />o o Controller ® and greater than one year in length per the City Purchasing <br />a = m Policy <br />0 Other Appropriate Reviewers ❑ <br />Check the Appropriate Item Tvae — Reauired for AH Submissions <br />Required Information <br />Company or Vendor Name <br />Agreement <br />El <br />Contract I <br />Z <br />Proposal <br />I El <br />Addendum <br />Project Number <br />Claim <br />Funding Source <br />SSDA TIF <br />Bid Opening <br />❑ <br />Bid Award I <br />El <br />Req. to Advertise <br />❑ Title Sheet <br />El <br />Quote Opening <br />❑ <br />Quote Award <br />Ch Order No. <br />0 <br />C/O & PCA No. <br />PCA <br />❑ <br />Ease. /Encroach. <br />Traffic Control <br />Resolution <br />❑ <br />Other: <br />Required Information <br />Company or Vendor Name <br />Christopher B. Burke Engineering <br />New Vendor <br />❑ Yes <br />$ <br />No ❑ If Yes, Approved by Purchasing <br />Project Name <br />Fellows Street Corridor Improvement Project - Supplement #1 <br />Project Number <br />Not yet assigned) 1JZ.-t)bG- <br />Funding Source <br />SSDA TIF <br />Account No. <br />430 - 1050 -460 -31.06 <br />Amount <br />$ 185,000.00 <br />Terms of Contract <br />Purpose /Description <br />Design service proposal for Fellows Street Corridor Improvement <br />Proiect, Phase 2 <br />For Chanae Orders Onlv <br />Amount of <br />❑ <br />❑ <br />Increase <br />Decrease <br />$ <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Copy Original <br />Dispersal After Approval <br />Jason Durr, CBBE <br />Bill Schalliol, CED <br />