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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/27/2020 <br />Department Public Works <br />Name Alicia Czarnecki/Sue <br />Ellen Doudrick Division/Bureau Engineering <br />BPW Date 11/10/2020 <br />Phone Extension 5903 <br />Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name: Clara McDaniels <br />Controller ® <br />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 <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement Amendment <br />❑ Contract ❑ Proposal ❑ Addendum <br />® Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control: <br />I-1 Other: <br />Required Information <br />Company or Vendor Name <br />Jones Petrie Rafinski Corp. <br />❑ Yes ® No ❑ If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Riverside Drive Bank Stabilization <br />Project Number <br />118-005B <br />Funding Source <br />Stormwater Fund (Professional Services) <br />Account No. <br />667-605-517-431002 <br />Amount <br />$31,105.00 <br />Terms of Contract <br />Hourly Not to Exceed <br />Purpose/Description <br />Temporary easement acquisition support for the Riverside Drive <br />Bank Stabilization Project <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of ❑ Increase <br />$ <br />❑ Decrease <br />$ <br />Previous Amount $ <br />Current Percent of Change: <br />% <br />New Amount $ <br />Total Percent of Change: <br />% <br />