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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/26/2023 <br />Department Public Works <br />Name Rebecca Maenhout Division/Bureau Engineering <br />BPW Date 02/14/2023 <br />Phone Extension 5996 <br />Required Prior to Submittal to Board <br />Legal ❑ <br />Attorney Name: Michael Schmidt <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 />Michael Schmidt <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 Lochmueller Group <br />❑ Yes ® No ❑ If Yes, Approved by <br />New Vendor Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Seitz Park Reconstruction <br />Project Number 117-093A <br />Funding Source PO-007779 Parks & Recreation <br />Account No. 436-10-102-121-444000— PROJ00000079 <br />Amount $209,560.00 <br />Terms of Contract Hourly NTE <br />Purpose/Description Amendment No. 1 Covers additional Construction Inspection <br />Services for Seitz Park Reconstruction Phase 1. <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 />❑ 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 />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />