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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/05/2019 <br />Department Public <br />Name Zach Hurst Works / En inecrin <br />BPW Date 11/12/2019 Phone Extension 3057 <br />..... <br />Re <br />quired Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney <br />Purchasing <br />❑ Attorney Name <br />F] <br />Check the <br />Item Type - Requiredfor All Submissions <br />H Professional Services Agreement LJ Contract ❑ Proposal <br />Open Market Contract Z Amendment/Addendum E, Special Purchase, QPA <br />Bid Opening Bid Award [-] Req. to Advertise <br />EJ Quote Opening Quote Award ❑ Reject Bids/Quotes <br />Proposal Opening ❑ C/O & PCA No. F-] PCA <br />E] Chg. Order, No. ❑ Traffic Control EJ Resolution <br />Other: E, Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />hristo <br />Yes <br />No <br />Information <br />B. Burke <br />If Yes, Approved by Purchasing <br />❑ Title Sheet <br />0 MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />East Race Sewer Analysis <br />118-090 <br />.............. ................ <br />River East TIF <br />429-1050-460-31.02 <br />$48,400.00 <br />Amendment No, 1 for design services to account for revised flow inform°natic <br />and aesthetic updates. <br />__ ... <br />For Change Orders Onl <br />Amount of Increase $ <br />[� Decrease ($ ) <br />Previous Amount $ <br />Increase % <br />............. <br />Current Percent of Change: Decrease ( % <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease( % <br />Time Extension Amount: <br />New Completion Date: <br />