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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/29/2020 <br />Department <br />Name Zach Hurst Engineering <br />BPW Date 10/13/2020 Phone Extension - <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney <br />❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item I <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />n Other: <br />® Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />U Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />Company or Vendor Name SmithGroup <br />New Vendor ❑ Yes[:] If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Project Name Seitz Park <br />Project Number 117-093A <br />Funding Source 2018 TIF Park Bond <br />Account No. 452-11-206-289-444000, PO-0001787 <br />Amount $89,000 <br />Terms of Contract <br />Purpose/Description Amendment number 3 to this PSA covers additional design effort, as well as <br />construction administration services. <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 />