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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />05/7/2019 <br />Kieran Fah <br />Department LTCP <br />BPW Date 05/14/2019 Phone Extension 5993 <br />Rewired Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels ._._ __._. ....�. <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />Check the <br />❑ Agreement <br />® Professional Services <br />❑ Bid Opening <br />El Quote Opening <br />Change Order No. _ <br />Ease/Encroach. <br />Other: <br />m�ate Item <br />e.m <br />Conract� <br />Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />for All Submissions <br />p ❑ Addendum <br />� Proposal <br />❑ Req. to Advertise ❑ Title Sheet <br />Rewired Information <br />Company or Vendor WName:-•A erie n-Stfuctur- p+ei-nt— <br />❑ PCA <br />In <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name Green Stormwater Infrastructure Master Plan <br />Project Number <br />118-040.1 <br />Funding Source <br />_ ............... _.. <br />Wastewater O&M -(Sewer De t s contractual bud et <br />�........... q�� <br />Account No. <br />641-0621-792.63-35 <br />Amount <br />........................w� _�._.................. ......... ..�... <br />$ 40,000 <br />Terms of Contract <br />City masterplan to reduce CSO via GSI w <br />Purpose/Description <br />LTCP relook has highlighted 9 key CSO basin tobe tackled with <br />GSI instead of Grey infrastructure this progresses that effort. <br />El Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment E=Vey, Iran, etch <br />... <br />Required For Change Orders OnI <br />Amount of El <br />..._.. ................... _......._. <br />Increase $ <br />Decrease $ <br />Previous Amount <br />CurrentPercent of Change: %....................�u.............................................aa__a��_...............................................r_........................... <br />New Amount <br />.....................�w...........................................m.......e.._m.............................m........... _.......�.�.�......................... <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy Original <br />® j <br />Jordan McCormack at American Structurepoint. <br />b........_ .. rue repo int com <br />�da c ormack sctur t ......� <br />❑ F] <br />mm , ... ..... ........................... <br />El..................��...............................................�.�.�.�.�.�.�.�. <br />�......... ......................... <br />.� ,...�. <br />