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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/6/2020 <br />Name Kyle Silveus Department Engineering <br />BPW Date 4/14/2020 Phone Extension 9083 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ Michael Schmidt <br />Check the Appropriate Item Tvpe — Required for All Submissions <br />U Agreement U Contract L] Proposal L] Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I-1 Other: <br />uired Information <br />Company or Vendor Name Lochmueller Group, Inc. <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Historic Leeper Park Improvements — Bid Package 2 <br />Project Number 118-010B <br />Funding Source <br />RW TIF Bond <br />Account No. <br />452-1101-452-31.02 <br />Amount <br />$ 6,000 <br />Terms of Contract <br />Amendment 2, Hourly Not to Exceed <br />Purpose/Description <br />Redesign of overlook foundation plan due to field conditions <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ❑ <br />Kyle Silveus <br />® ❑ <br />Patrick Sherman <br />❑ ❑ <br />