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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/5/2020 <br />Department <br />Name Charlotte Brach Engineering <br />BPW Date 11/24/2020 Phone Extension 9246 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ Officer Name <br />and Inclusion Officer <br />BPW Attorney <br />❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type — Re uired or All Submissions <br />® Professional Services Agreement <br />❑ Contract <br />❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />❑ Resolution <br />n Other: <br />n Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Information <br />Jones Petrie Rafinski <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />E] MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />120-062 3400 Block S Michigan Streetscape Improvements <br />PROJ00000216 <br />TIF — Southside Development #1 <br />430-10-102-121-442001-PROJ00000216 <br />Lump Sum <br />Professional Services Agreement with Jones Petrie Rafinski for design <br />services for streetscape improvements for the 3400 block of S Michigan <br />Street. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Increase <br />Decrease <br />Increase <br />Decrease <br />New Completion Date: <br />