Grants for Temporary Easement & for Permanent Easement for Storm Sewer at Sampson and Overlook Ct. - Neil and Barbara Andrews

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 1 /21 /20 Name Sue Ellen Doudrick Department Public Works Division/Bureau Engineering BPW Date 1/28/20 Phone Extension 5922 RITired Prior to Submittal to Board Legal Attorney Name: Clara McDaniels Controller El Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing Michael Schmidt ... M... Check the Annro riate Item Type — e 'p 4rAd for All Submissions Agreement Amendment F] Professional Services Bid Opening ❑ Quote Opening ❑ Change Order No. ® Ease/Encroach. Other: Company or Vendor Name Contract Resolution [l Bid Award Quote Award [� C/O & PCA No. Traffic Control: New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract F Proposal ❑ Req. to Advertise Required Information Neil and Barbara Andrews ❑ PCA Addendum ❑ Title Sheet ❑ Yes ® No ❑ If Yes, Approved by P�IT �urchasi_.......................... MBE ❑ WBE . _......__ ........ ........ _.......... No [] Yes Name of Com an Small Drainage Design and Repair — Sampson and Overlook 118-063B ..._._� . ��...�...................... ....... _ _..... n/a na........................._�.. ............................. See attached easement document Purpose/Description Easement needed for the installation of a storm sewer, ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) Amount of El Increase $ _,�.......... n Decrease $ Previous Amount $ Current Percent of Change;-%......_W.... New Amount _ ��..._.............�. ....._. ......��. Total Percent of wChan:._. _._.%° . mmmmm mmm _................ Dis ersal After �pproval Copy Original ® ❑ Kara Boyles ® ❑ Sue Ellen Doudrick El❑� .............................. _��.........