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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />►ErUM <br />May 1, 2019 <br />Alicia Czarnecki <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date May 14, 2019 Phone Extension 5903 <br />_........._ .... <br />ITRequired Prior to Submittal to Board <br />Legal Attorney Name: Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />Check the A <br />Agreement Amendment <br />Professional Services <br />[� Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />F-1 Ease/Encroach. <br />FI Other: <br />Company or Vendor Name <br />iropriate Item Type..- <br />Contract <br />El Resolution <br />❑ Bid Award <br />El Quote Award <br />n C/O & PCA No, <br />F1 Traffic Control: <br />for All Submissions <br />.....__ ........ <br />Proposal <br />[:] Req. to Advertise <br />Reauired Information <br />F:1 PCA <br />Addendum <br />❑ Title Sheet <br />Seven Generations Architecture & En ineerin , LLC <br />.. <br />Yes No If Yes, Approved by <br />New Vendor <br />Purchasin <br />MBE/WBE Contractor <br />...............................w <br />MBE WI <br />MBE/WBE Contractor <br />Requested <br />__ <br />No Yes Name of Company ....... <br />Project Name <br />Muessel Grove Public Restroom <br />Project Number <br />118-099 <br />Funding Source <br />.................. .......................... w ................... ......m <br />VPA Capital <br />...._..........._..................................... __ <br />Account No. <br />416.0404.453.36.01 <br />Amount <br />1: $2,100.00 New Contract Amount: $21,900.00 ������ <br />Terms of Contract <br />_Amendment <br />AdditionalServicesfor Waterline Reel ..................... WW <br />ReplacementmmDesicn in <br />Purpose/Description <br />addition to Base Bid services. <br />mms Certification........ ............... <br />Required Contractor__ ... <br />' Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />_.❑ <br />Required For Change Orders Only <br />Amount of <br />Increase $ <br />E] <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: % ........................._................._.... <br />NewAmount <br />www�� __�.-��._ ................__�.. ......._........_��. <br />......... _.... ....... _______................ <br />Total Percent of Change: <br />....._............_............%......_ <br />Dispersal After Approval <br />Copy Original <br />® <br />Alicia Czarnecki, Project Engineer <br />.. <br />® ❑ <br />Cit E n i n .............. __._- - <br />Kara Boyles, y g' eer, PE ..................... <br />® 0 <br />Patrick Sherman, VPA Project Manager <br />