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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 4, 2019 <br />Name —Roger Nawrot . .... . ...... - Department Engineerin <br />BPW Date November 11, 2019 Phone Extension 5932 <br />�mmmmmmmNmmmmmmmlmillillimillm <br />.. .... . ........... <br />,N!4ired Prior to Submittal " t ' o 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 <br />.... ................. . ... <br />Check the App o ate IttT Type 7Re <br />quired uireq for All Submissions <br />.......... IT�mITITITmmAgreement Contract 17"P"ropo sal E] Addendum <br />F-1 Professional Services F-1 Resolution <br />Bid Opening E] Bid Award ❑ Req. to Advertise E] Title Sheet <br />Quote Opening [] Quote Award <br />❑ Change Order No. ❑C/O & PCA No. E] PCA <br />Ease/Encroach. Traffic Control <br />Other: Amendment No. 2 <br />Reauired Information <br />Company or Vendor Name <br />Lawson -Fisher Associates P.C. <br />........... <br />0 Yes Z No❑ if Yes, Approved by <br />New Vendor <br />Purchasing ..... . ......... <br />MBEIWBE Contractor <br />E] MBE WBE <br />MBE/WBE Contractor Requested <br />I No E] YesmmmName of Company . . . ............. <br />Project Name <br />East Bank Trail Slope Stabilization Design Se "ic s. <br />Project Number <br />118-306 <br />Funding Source <br />Liability Insurance Fund <br />­11­11­.­_­­­­.­ . ......... <br />Account No. <br />226-0419-672.42-03 <br />Amount <br />2,800.00 <br />Terms of Contract <br />NTE <br />Purpose/Description <br />. . ..... . .................... .. . . <br />The rebid of the . . ....... <br />'.proiect required bid documents be prepared <br />instead of guote documents that was previously done. The total <br />contract amount with this amendment is $10,240.00. <br />El Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />R <br />Amount of F1 increase $ <br />1:1 Decrease $ <br />Previous Amount $ <br />.................................... Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />D <br />E] <br />For ChaNl:e Orders Only <br />.............. <br />Disi)ersal After <br />