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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date4/17/20 <br />Department <br />NameKyle SilveusEngineering <br />BPW Date4/28/20Phone Extension9083 <br />Required Prior to Submittal to Board <br />LegalAttorney NameClara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more and <br />Controller <br />greater than one year in length per the City Purchasing Policy <br />PurchasingMichael Schmidt <br />Check the Appropriate Item Type –Required for All Submissions <br />AgreementContractProposalAddendum <br />Professional ServicesResolution <br />Bid OpeningBid AwardReq. to AdvertiseTitle Sheet <br />Quote OpeningQuote Award <br />ChangeOrder No. C/O & PCA No. PCA <br />Ease/Encroach.Traffic Control <br />Other: <br />RequiredInformation <br />Company or Vendor Name AbonmarcheConsultants, Inc. <br />New Vendor YesNoIf Yes, Approved by Purchasing <br />MBE/WBE Contractor MBEWBE <br />MBE/WBE ContractorRequestedNoYes Name of Company <br />Project NameEagle Way Sewer Extension <br />Project Number 119-095 <br />Funding SourceRWDA TIF <br />Account No. <br />324-1050-460-31.02 <br />Amount$2,790 <br />Terms of ContractHNTE <br />Purpose/DescriptionAmendment for adjustment ofbidding documents due to the <br />building contractor's borrow pit and preparing re-bid documents. <br />Required Contractor’s Certification Form Attached(Non- <br />Collusion, Non-Discrimination, Non-Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />$ <br />Increase <br />Amount of <br />Decrease$ <br />Previous Amount$ <br />Current Percent of Change: % <br />New Amount$ <br />Total Percent of Change:% <br />Dispersal After Approval <br />Copy Original <br />