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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/18/2019 <br />Name Sue Ellen Doudrick Department Eng. <br />BPW Date 2/26/2019 Phone Extension 5922 <br />nm <br />leuired Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDanicls <br />Dept. Attorney Attorney Name <br />Purchasing ® Michael Schmidt <br />Check the Appropriate Item Type -- <br />Professional Services Agreement ❑ Contract <br />Open Market Contract <br />0 Amendment/Addendum <br />Bid Opening <br />El Bid Award <br />F Quote Opening <br />❑ Quote Award <br />EJ Proposal Opening <br />❑ C/O & PCA No. <br />❑ Chg. Order, No. <br />Traffic Control <br />Other: <br />All Submissions <br />H Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />Q Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />�........._._..... <br />_..._ Required Information <br />Company or Vendor Name <br />Lawson Fisher Associates <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />MBE/WBE Contractor <br />MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Project Name <br />South Bend Dam 2019 DSSMR <br />Project Number <br />_............... .... ..... ..... <br />119-020 <br />Funding Source <br />_... .............. <br />Professional Services <br />Account No. <br />_......._. ._..... .... ..__.. <br />101.0602.431.31 06 <br />Amount <br />$3,300 <br />Terms of Contract <br />HNTE <br />Purpose/Description <br />.......-....... ...... ......... <br />Preparation of 2019 Dam Safety Surveillance and Monitoring Report <br />(DSSMR) for the South Bend Dam due to Federal Energy Regulatory <br />Commission (FERC) <br />yearly <br />For Cl�au�Orders Only.... <br />Amount of <br />Increase $ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />�.............. <br />- .................. <br />Increase % <br />Current Percent of Change: <br />........_ ......_ <br />Decrease %) <br />New Amount <br />$ ........... ._.................. .... <br />o __._........_........ <br />/o Increase <br />Total Percent of Change: <br />0 <br />Decrease ( /o) <br />Time Extension Amount: <br />New Completion Date: <br />...... ................. ._..._ ... .... .. <br />