PSA -Traffic Engineering On-Call Services – American Structurepoint, Inc.

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/10/19 Name Alicia Czarnecki Department Engineering ............... BPW Date 12/19/19 Phone Extension 5903 - L . . ....... .e r�ard Prior to Submittal to Board BPW Attorney Attorney Name Dept. Attorney 0 Attorney Name Purchasing El Check the Appropriate ltepj�FjlLc - z �. edf6r All Submissions Professional Services Agreement F-I contract .. &c� [J Proposal [] Open Market Contract El Amendment/Addendum [:J Special Purchase, QPA F-1 Bid Opening [:] Bid Award El Req. to Advertise El Title Sheet 0 Quote Opening E] Quote Award E] Reject Bids/Quotes F-1 Proposal Opening C/O & PCA No. E] PCA F-1 Chg. Order, No. F-1 Traffic Control ❑ Resolution F-1 Other: Ease./Encroach Reauired Information Company or Vendor Name American Stru��,fttrc jit)jnt ........................ ......... ........... ............... Yes[:] If Yes, Approved by Purchasing New Vendor F-1 No [:] Y es ElCompleted MBE/WBE Contractor E-Verify Form Attached WBE o F] N Project Name Traffic E.-ij g neering..' On ' Call .................. Project Number 119-111 Funding Source Engineering, Professional Services / L.RSA Professional Services ... ............... Account No. 101-0602-431-31-06 / 251-0608-431.31-06 Amount $45,000.00 Terms of Contract ......................... ..... NTE Purpose/Description —Traffic "Engjneerjng On Call Services Amount of ❑ increase $ ----------------------- Decrease ($ Previous Amount .............................. $ - - — ------------ - ---------- Increase % Current Percent of Change: ..... .......... Decrease %) . . . ..... ................... -- ............ New Amount . ............ $ . .............. ...............------ — ------------------------- Increase % Total Percent of Change: ....... ..... Decrease %) .......... Time Extension Amount: .... ....................... New Comnletion Date: ................ ......... ...