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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/4/2019 <br />Name Kieran.....ahe Department Public Works <br />� F.....................� ...�. <br />BPW Date 3/12/2019 Phone Extension 5993 <br />immmmmiHUHuwuwiuwiu�uiuiuiuiuiuwuw.wiuiumirc� � � uo�ueu��m�a�r�r� �tiw�:ma ru�norw,� � v mmuuuuuuuummuuuumumwu�uuuumw�unrtmmrm�mrr�+imr <br />q�._. e uired Pno........_._r to Submittal to Board <br />Legal ® Attorney Name <br />Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the <br />H Agreement <br />® Professional Services <br />E] Bid Opening <br />F-1 Quote Opening <br />EJ Change Order No. _ <br />0 Ease/Encroach. <br />El Other: <br />)ro riate Pe <br />Contract � T <br />❑ Resolution <br />❑ Bid Award <br />Quote Award <br />C/O & PCA No. <br />Traffic Control <br />p <br />or All Submissions <br />� Pro osal EAddendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />❑ PCA <br />Company or Vendor Name: Stantec Consulting Services <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE F] WBE <br />MBE/WBE Contractor Requested <br />❑ No F_J Yes Name of Company <br />Project Name <br />TCP renecgotiation <br />L ��mmmmmm <br />Project Number <br />117-056.6 <br />Funding Source <br />_.... <br />Wastewater Professional Services Engineering (LTCP) <br />.,........... da <br />Account No, <br />641-0630-793-3201 <br />Amount <br />$ 200,000 <br />Terms of Contract <br />_ <br />Not to excee�.�.�.�.�.�.�... � <br />d the above amount <br />Purpose/Description <br />For rene otiation of_new LTCP <br />], Required Contractor's Certification Form Attached (Non- <br />.mm..._......._ <br />Collusion, Non Discriminatio t, Non -Debarment E Verify„ Iran„ etc.) <br />.. _... <br />aired For Change Orders Only <br />g............._. <br />El Increase $ <br />Amount of am. <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />New Amount <br />na as _..... ............. <br />$ <br />Total Percent of Change: <br />._......._.................................. ................ mm ....................� <br />% <br />Dispersal A ..................__�.p_p—ro... _ .... <br />fter Approval <br />Copy Original <br />El El <br />0 � <br />..��.............._____w...........� w............................................��.�.�..........�_..m..m..m.. . — .......... <br />