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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/22/2022 <br />Name Antonius Northern Department: DCI <br />BPW Date 06/28/2022 Phone Extension 5823 <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney X Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br /> <br />Purchasing <br />Check the Appropriate Item Type – Required for All Submissions <br />X Professional Services Agreement Contract Proposal <br /> Open Market Contract X Amendment/Addendum Special Purchase, QPA <br /> Bid Opening Bid Award Req. to Advertise Title Sheet <br /> Quote Opening Quote Award Reject Bids/Quotes <br /> Proposal Opening C/O & PCA No. PCA <br /> Chg. Order, No. Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name Jones Petrie Rafinksi Corporation <br />New Vendor Yes If Yes, Approved by Purchasing <br />X No <br />MBE/WBE Contractor MBE <br /> WBE Completed E-Verify Form Attached Yes <br /> No <br />Project Name DTSB Façade Grant <br />Project Number 121-065 <br />Funding Source DCI – Small Business Assistance <br />Account No. PR-00011774 <br />Amount <br />Terms of Contract Hourly <br />Purpose/Description Amendment of the original Professional Services Agreement to increase the <br />scope of services, extend the contract period and clarify the fee service <br />schedule related to the performance of the services. <br />_______________________________________________________________ <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br /> % <br />( %) <br /> New Amount $ <br />Total Percent of Change: <br />Increase <br />Decrease <br /> % <br />( %) <br /> Time Extension Amount: <br />New Completion Date: <br />