Professional Services Agreement - American Structurepoint Inc - Pinhook Water Treatment Plant

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Date Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM March 19, 2019 Alicia Czarnecki Department Engjnecring BPW Date March 26 2019 Phone Extension 5903 i�ma�mm�mm�mm�mmmmm�mmmmmmm�m mmmm�mmm e Required Prior to Submittal to oard BPW Attorney Attorney Name Dept. Attorney Z Attorney Name ..................................................... ... Purchasing Check the Appropriate Item Type -- Professional Services Agreement F-1 Contract Open Market Contract Amendment/Addendum ❑ Bid Opening Bid Award �j Quote Opening I❑ Quote Award Proposal Opening ❑ C/O & PCA No. Chg. Order, No. ❑ Traffic Control ❑ Other: iced Information Company or Vendor Name American StrUcturepoint, Inc. New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description All Submissions Proposal Special Purchase, QPA ❑ Req. to Advertise Ej Reject Bids/Quotes PCA Resolution Ease./Encroach Yes J I If Yes, Approved by Purchasing No ❑ Title Sheet ❑ WBE Completed E-Verify Form Attached ❑❑ Nos Pinhook Water Treatment Plant Improvements .a.�.ww 119-003 Water Ca $179,400.00 NTE � �...�.-...... For (Ii nE Orders Only Amount of Increase $ w ❑ Decrease ($ ) PreviousAmount $ ___..��.�__�.... �.�_ �... �...��...��_................_........_�........._ Increase ..... .................. _........._.�...._........_.............. % Current Percent of Change: Decrease ( ......._....... %) New Amount $ _.................. Increase % Total Percent of Change: Decrease ( %) Time Extension Amount: New Completion Date: