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Date <br />Name <br />12-19-16 <br />Corbitt Kerr <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 12-22-16 Phone Extension 5931 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: MS <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 <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />® Other: Amendment No. 3 <br />Required Information <br />Company or Vendor Name Lawson —Fisher Associates, P.C. <br />es U No U If Yes, Approved by <br />New Vendor Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Com <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Update of City of South Bend Construction Standards <br />115-116 <br />Utility Expense / Contractual Service — Other <br />Professional Services/Other Professional Svcs <br />641-0621-792.63-35 $48,000 <br />101-0602-431.31-06 $10,000 <br />Hourly Rate Not -To -Exceed <br />Revise City Standards and Specifications <br />LJ 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 />❑ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanae: <br />py <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />