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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11 /04/2016 <br />Richard Estes <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 11/08/2016 Phone Extension 5896 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <br />Controller ❑ 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 ® George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />® <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control: <br />❑ <br />Other: <br />Required Information <br />Company or Vendor Name <br />Christopher B. Burke Engineering, LLC. <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE I I WBE <br />MBE/WBE Contractor Requested LJNoLJYes Name of Company <br />Project Name <br />South Bend Dam Capital Improvement Plan <br />Project Number <br />116-095 <br />Funding Source <br />Account No. <br />Amount <br />Not to Exceed $45,000 (subject to funding from redevelopment) <br />Terms of Contract <br />Purpose/Description <br />South Bend Dam Capital Planning <br />U Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />uired For Change Orders <br />Amount of H Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanae: <br />py Original <br />® ❑ Eric Horvath <br />® ❑ Bnan McKenna (Burke Engineering) <br />® ❑ Patrick Kerr <br />