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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/319 <br />Name Kyle Silveus Department EngineerNng <br />BPW Date 12/10/19 Phone Extension 9083 <br />mumm�mmmmrmMIMMm mwermwa in mmommmmmmm����wwmm OMWEwummumE mum <br />_ Rqgqirecl 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 ❑ Michael Schmidt <br />Check the <br />Agreement <br />Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Change Order No. <br />❑ Ease/Encroach. <br />Other: <br />wr priate Item Tir e <br />El Contract <br />Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo. <br />_ <br />❑ Traffic Control <br />for All Submissions <br />I Proposal R Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />ired Information <br />❑ PCA <br />Company or Vendor Name Abonmarche Consultants Inc. <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE WBE <br />MBE/WBE Contractor Requested ❑ No [1 Yes Name of Company <br />Project Name Eacgle Wad/ Sewer Extension <br />.................. <br />Proiect Number 119-095 <br />Funding Source RWDA TIF <br />WWWWWW .N.ww... <br />Account No. 324-1IT050-460-31.02_ .. ...... ... <br />_._._..........- ........................a <br />Amount $ 2,400 <br />Terms of Contract LS <br />Purpose/Description Amendment for subsurface investigation for d aign <br />si n <br />n Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Vorifv, Iran, etc. <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />F <br />❑ <br />