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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/24/2018 Department Public Works <br />Name Sue Ellen Doudrick Division/Bureau Engineering <br />BPW Date, 9/25/2018 Phone Extension 5922 <br />R aired Prior to Submittal to hoard <br />Legal Z Attorney Name: Clara McDaniels <br />Controller z 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 Z Michael Schmidt <br />Z Agreement Amendment <br />El Contract Ll Proposal Ll Addendum <br />F Professional Services <br />F Resolution <br />F Bid Opening <br />EJ <br />Bid Award Req. to Advertise E] Title Sheet <br />EJ <br />Quote Opening <br />El <br />Quote Award <br />E] <br />Change Order No. <br />F-1 C/O & PCA No. F1 PCA <br />F-1 Ease/Encroach. <br />❑ Traffic Control: <br />F— <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEA(VBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Donohue & Associates <br />F1 Yes E No If Yes, Approved by <br />Purchasing, <br />E] MBE 0 WB,E <br />F No E] Yes Name of Company <br />South Well Field Improvements <br />117-059 <br />SSDATIF <br />Amendment Total $100,000 (New Total + Original PSA = $250,0001) <br />Of the new totai, $14,500 is HNTE, The remaining amount is Lump Sum. <br />Terms of Contract <br />Purpose/Description South Well Field Improvements — Design & Bidding Services <br />(Lumps Sum) and Easement Acquisition Services (HNT ;) _ <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change,Orders On!y <br />Amount of ❑ increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />I Dispersal After Approval <br />Copy Original <br />F1 Ed Herman <br />F-1 Ron O'Connor <br />❑ <br />1-1 <br />