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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 15, 2019 <br />Name Roger T. Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date August 26, 2019 Phone Extension 5932 <br />Required Prior to Submittal to Board <br />.. . ........... . ................ . . . . . ...... . ... . ................ ..... . ....... J <br />Legal Attorney Name: <br />Controller El Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />L_J Agreement Ll <br />Contract LJ Proposal LJ Addendum <br />Z Professional Services 0 <br />Resolution <br />F-1 Bid Opening El <br />Bid Award El Req. to Advertise El Title Sheet <br />Ej Quote Opening El <br />Quote Award <br />0 Change Order No. <br />C/O & PCA No. E] PCA <br />F1 Ease/Encroach. <br />Traffic Control: <br />F-1 Other: Amendment No. 1 <br />Company or Vendor Name <br />Abonmarche Consultants, Inc, <br />.. ........... - --- — ------ . . . ............ <br />F Yes Z No If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEIWBE Contractor <br />El <br />MBE <br />. ............ <br />F1 WBE <br />MBEIWBE Contractor Requested <br />... <br />.. .... <br />......... .... —,— <br />No .. . . <br />Name of Com ny <br />. ..... .... . P�! _ ........... <br />Project Name <br />Mayflower Road and Adams Road Traffic Impact Stud <br />Project Number <br />119-075 <br />Funding Source <br />............. <br />RWDA <br />Account No. <br />324.1050.460.31-02 <br />Amount <br />__$_28,406.00— ----­-------- - --- . .............. .......... ... ------ <br />Terms of Contract <br />----------------- <br />Lump Sum.......... <br />Purpose/Description <br />BOPW approval subject to RDC approval of funding on August <br />29,2019 <br />- ------ - . . . . . . . .. ................. Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />.... .. ...... -_ - <br />Reqolred For Chang0.0rders.0 <br />Amount of <br />.. <br />—1 <br />I n c re as e <br />Decrease <br />....... <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />.......... <br />Total Percent of Chana!e:mmmmmmmm % <br />Dispersal After Approval <br />Copy Original <br />F-1 F-1 <br />El F-1 <br />1-1 El <br />