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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 1, 2019 Department Public Works <br />_. .-........ ......_._ <br />Name Alicia Czarnecki/Patrick Sherman Division/Bureau Engineering <br />Purchasing <br />Check thi <br />Agreement Amendment <br />El Professional Services <br />n Bid Opening <br />El Quote Opening <br />E Change Order No. <br />Ease/Encroach. <br />❑ Other: <br />LJ Contract <br />0 Resolution <br />El Bid Award <br />M Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control: <br />Proposal <br />❑ Req. to Advertise <br />PCA <br />_�Addendum <br />❑ Title Sheet <br />Company or Vendor Name DLZ <br />❑ Yes No ❑ If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBE/WBE Contractor <br />❑ MBE WBE <br />MBE/WBE Contractor <br />Requested .... <br />q _.^No 0 Yes Name of Compaq <br />Project Name <br />Pinhook Park Improvements Project <br />Project Number <br />118-077 <br />Funding Source <br />Park Bond Series H <br />Account No. <br />�._ _.M _ _ .. ............. ........ <br />471-1136-452.31.02 <br />Amount <br />Amendment 2: $121,800.00 New Contract Amount: $187,050.00 <br />Terms of Contract <br />Lump Sum for desi n services; Not to Exceed <br />Purpose/Description <br />Amendment 2 for the Additional Services of Construction Documents, <br />Permitting, Testing„ Bidding Assistance, and Construction Services. <br />_..._ <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />%t d FQr' Ord �J <br />� <br />Amount of ' <br />Increase $ _ __.. <br />El <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />New Amount <br />$ <br />Total Percent of Chan e: <br />Dispersal After A royal <br />Copy Original <br />® ❑ <br />Alicia Czarnecki, Project Engineer <br />® ❑ <br />Kara Boyles, City Engineer, PE <br />® ❑ <br />Patrick Sherman, VPA Project Manager <br />