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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 12, 2019 <br />Name Roger T. Nawrot <br />Purchasing <br />Check the <br />p,.j Agreement <br />Professional Services <br />Bid Opening <br />Fl Quote Opening <br />M Change Order No. <br />El Ease/Encroach. <br />Other: Amendment #1 <br />Company or Vendor Name <br />Department Public Works <br />Division/Bureau Engineering <br />iropF1 Contract or All Submissions <br />nate Item �rpe -Required Proposal <br />Resolution <br />❑ Bid Award Req. to Advertise <br />El Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Required Information <br />Jones Petrie Rafinski Cor <br />ration <br />Li Yes N No <br />Purchasing <br />MBE ❑ WBE <br />w <br />No F1 ITYes Name of Com <br />Addendum <br />❑ Title Sheet <br />If Yes, Approved by <br />Downtown East-West Streetscape <br />......... <br />117-041 _...... <br />$24,194.00 <br />Not to Exceed <br />This includes the additional design work additional design work <br />at John Hunt Plaza, reconfigure the traffic signal detection at <br />Michigan Street & Colfax Avenue, revision to the plaza area at <br />the LaSalle Hotel, addition of a storm sewer during the final <br />design period and design sidewalk over an existing vaulted <br />basement. The total contract amount with this amendment is <br />16„454.00 <br />....... _.... <br />J Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />m .......... �R uired. For Change Orders OnP,y�....... _mm..�....__M. <br />Amount of Increase $ ...... .._.......... .. _.............. <br />_ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change:. % <br />New Amount $ <br />Total Percent of Chanqe: % <br />...� _ _.._ . Dispersal After Approval <br />Copy Original <br />