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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/17/2020 <br />Department <br />Name Sue Ellen Doudrick Engineering <br />BPW Date 3/24/2020 Phone Extension 5922 <br />m a <br />Review and Approval Required Prior to Submittal to Board <br />_..._._...._.__.............�..............._.... ........._ _ .. _ _ _ ..._................. <br />Diversity Compliance ❑ Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney F] Attorney Name <br />Purchasing] <br />Check the Appropriate Item 3"° e — <br />Professional Services Agreement Contract <br />F-1 Open Market Contract <br />® Amendment/Addendum <br />]' Bid Opening <br />❑ Bid Award <br />Quote Opening <br />❑ Quote Award <br />EJ Proposal Opening <br />❑ C/O & PCA No. <br />Chg. Order, No. <br />❑ Traffic Control <br />Other: <br />Rpgq i j d Information <br />All Submissions <br />Proposal <br />IH Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />�] PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />Company or Vendor Name <br />Christopher B. Burke Engineering, LLC ............................... <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />MBE <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ Nos <br />E <br />Project Name <br />South Bend Dam 2020 DSSMR <br />Project Number <br />J <br />.... _._... ............................. <br />111 2 <br />Funding Source <br />....19 ....... <br />Stormwater Fund <br />Account No. <br />667-0621-792-4204 <br />Amount <br />_................._. .......... <br />$32,'�00 <br />Terms of Contract <br />..............�..w---....�. � ��_.����� � ..............._...... .............w..........�. <br />HNTE <br />Purpose/Description Additional work will include tasks required by FERC: Bathymetric survey, <br />underwater inspection, staff gauge replacement design, dam ahead signage <br />design and coordination, yearly Gate Operation, and development of the <br />.. <br />For Change Orders Only <br />Amount of Increase $ <br />� .. mm_...... ........ ...... <br />El Decrease ($ <br />Previous Amount <br />$ <br />..._..__.....%... <br />Increase <br />Current Percent of Change: <br />Decrease <br />( % <br />New Amount <br />$ <br />Increase <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />