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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/07/2017 <br />Name Kieran Fahey Department LTCP <br />BPW Date 02/14/2017 QQ yp y Phone Extension 5993 <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 ❑ <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. _ <br />Ease/Encroach. <br />U Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />or Vendor Name: American Structurepoint <br />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name Leeper Park CSO Tank Design <br />Project Number 117-030 <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Wastewater <br />641-0630-793-31-02 <br />❑ Title Sheet <br />To undertake the Leeper Park CSO tank design -Project <br />Definition Statement <br />City's LTCP Consent Decree requires it commence design of the <br />Leeper Park CSO storage tank by 3/1/17. This contract satisfies that <br />federally mandated requirement. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of H Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />_ <br />❑ <br />❑ <br />_ <br />❑ <br />Jordan McCormack at American Structure <br />