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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />3/1 /2019 <br />Kieran Fah <br />Department Public Works <br />BPW Date 3/12/2019 Phone Extension 5993 <br />.. f ummflm�mu w rro umWum mmw. wuiuiuiui. mmmmmmmmmu�n ,. im�000mmmmmmm <br />..__............... <br />Re wired Prior to Submittal _toBoard <br />ITIT..........._.._ <br />Legal Attorney Name <br />Clara McDaniels <br />Controller (] Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the Api roriate Ite <br />m Type ... Required for Af" Subm._.. issi..o.....n..s <br />Agreement Contract Proposal <br />A .d._ endum. <br />Professional Services El Resolution <br />Bid Opening ❑I Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening El Quote Award <br />Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />Other: <br />Re iutred Information <br />Company or Vendor Name: Stantec Consulting Services <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name LTCP renegotiation-mmamendment to master agreement <br />Project Number 117-056 <br />Funding Source <br />_ not _ap licable <br />Account No. <br />�.-. w...._.....�.......................�......���.� �..............w <br />not aP�?licable� <br />Amount <br />$ 0 <br />Terms of Contract <br />Amendment to master a reement: additional time. <br />Purpose/Description <br />For renegotiation of new LTCP <br />EJ Required Contractor's Certification Form Attached (Non - <br />Collusion,. Non -Discrimination, Non -Debarment E-Verify, Iran, etc. <br />Required For Change Orders OnlyITIT <br />Amount of M Increase <br />wwww <br />$ <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change:. <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />. <br />Dispersal After Approval .. .. ..... .... ���.....�.wm_ <br />Copy Original <br />❑ ❑ <br />_.__..... ._.......,..�.......... mmw-� �..._... . <br />