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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/6/2020m mmmm <br />Department <br />PW- Long-term <br />Name Kieran Falre control Galan <br />BPW Date 1/14/2020 Phone Extension 5993 <br />o m <br />Review and Ap ova! Required Prior to Submittal to Board <br />..... _...... <br />Diversity Compliance ❑ Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney [ Attorney Name <br />Purchasing ❑ Not applicable, this is merely to add time to a no $ master <br />_ a reenient. Ori inal agreement a a roved by BPWs <br />he ACheck tpp ariate Item T : e °Wre ' o All Submissions <br />.._..w.... �.._� _. <br />LJ <br />Professional.a �....�... ,..�..._._ <br />Services Agreement E] Contract <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />E Bid Opening <br />❑ Bid Award <br />Quote Opening <br />Quote Award <br />E] Proposal Opening <br />F-] C/O & PCA No. <br />E] Chg. Order, No. <br />❑ Traffic Control <br />Fd Other: <br />Re ifired Information <br />U Proposal <br />El Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA <br />E] Resolution <br />Ease./Encroach <br />❑ Title Shee <br />Company or Vendor Name ,Stantec Consuitin aer� <br />New Vendor E] Yes If Yes, Approved by Purchasing <br />❑❑ No <br />MBE/WBE Contractor � WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name LTCP renegotiation- amendment to rrraster a reerrwent <br />Project Number 117-056 <br />Funding Sourcet. <t��l �......... d__ <br />Account No. oi,.a ..6lai .... ._............... <br />Amount No amount <br />Terms of Contract Amendment to master a reementadditional time. <br />Purpose/Description For renegotiation of new LTCP <br />�... For ObLpOrdqrsLbnf,. ... _.._ w. .. . <br />Amount of El Increase $ <br />Decrease ($ <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease _.................%o <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease ( % <br />