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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November, 4 2019 <br />Department <br />Name Jacob M. Klosinski Engineering / Utilities <br />BPW Date November :12 2019 Phone Extension Ext. 9496 <br />�a�anmm�mr r uamommm�imumwwmw�imiwmw�mm surn�nxuaee w NMPMPMmmmmmmMMMMEmm <br />,,.�.............. ...,. _ ....__. __.......... _ .... .._ ..._ ........................... <br />Require' Prior to Submittal to Board <br />... __ _.... _ _.......... <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. AttorneyAttorney Name <br />.........................._......ww.....w _...... .._._.... <br />........_.._ <br />Purchasing <br />Check the Appropriate Item T ype — <br />LJ Professional Services Agreement ❑ Contract <br />Open Market Contract <br />® Amendment/Addendum <br />F] Bid Opening <br />❑ Bid Award <br />[:] Quote Opening <br />❑ Quote Award <br />Proposal Opening <br />❑ C/O & PCA No. <br />❑ Chg. Order, No. <br />Traffic Control <br />❑ Other: <br />Reuuired Information <br />All Submissions <br />Proposal <br />LJ Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />E] PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />Company or Vendor Name <br />American Structurelj ... t, Inc -- <br />-._......................... .... <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />MBE El <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ Nos <br />Project Name <br />PTpyy RoadmLift Station <br />Project Number <br />119-073 <br />Funding Source <br />Utilities, Wastewater, Repair Parts & Other EquipmentwRepair & Mamt <br />Account No. <br />641-0630-793 31-02 <br />Amount$41,200 <br />(Original);mAmendment 1 adjustedyrice $48,770 (+$7,570) <br />Terms of Contract <br />Lump Sum (Hourly, Not to Exceed)._. <br />Purpose/Description <br />The Division of En Engineering and t t�litzm�.s_re requests approval ww <br />al of Amendment <br />No. 1 for the Professional Services Agreement for the sab'ect project to ad( <br />additional services for CSO 003 ro, air plans and Lift Station Life Cycle Qc <br />Anal sis. <br />- <br />For Chang rders 71_ <br />Amount of ❑ <br />Increase $ ..........�.___..................................... <br />Decrease �$ <br />Previous Amount <br />$ <br />Increase /o <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />$ <br />Increase % <br />Total Percent of Change: <br />............................................... .................... <br />Decrease ( %) <br />Time Extension Amount: <br />....... ...................._.._ w �� . <br />New Completion Date: <br />._........................_�................�a _....A...�������..... ..�...�.�.�.�_...�.�.�.�.�� <br />