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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 16, 2016 <br />Name <br />Roger Nawrot <br />Department <br />Engineering <br />BPW Date <br />December 22, 2016 <br />Phone Extension <br />5932 <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 [J George King <br />U Agreement L] Contract L] Proposal L] 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 />M Other: PSA Amendment No. 1 <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBENVBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Lawson- Fisher Associates P.C. <br />❑'Yes ® No L <br />❑ MBE ❑ WBE <br />I-1 No I-1 Yes Name of Com Da <br />COIT <br />404-0608-431.36-10 <br />$9,225.00 Total Amount of the Agreement $18,225.00 <br />Not to Exceed <br />This was for survey work and design to restore the road side ditch that <br />was altered by the adjacent land owner that caused the road shoulder to <br />washout. The original scope of services did not include survey work. <br />Required Contractor's Certification Form Attached (Non <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />® <br />❑ <br />® <br />❑ <br />Nawrot <br />Lawson — Fisher P.C. <br />