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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/01 /2018 <br />❑ Agreement <br />❑ Contract U Proposal U Addendum <br />Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />f-1 Other: <br />Company or Vendor Name <br />Jones Petrie Rafinski Corporation <br />New Vendor <br />❑ Yes 0 No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />McKinle Avenue and Fremont Park Improvements <br />Project Number <br />118-072 <br />t.RSA Utility Expense Contractual Service Fund / Engineering <br />Funding Source <br />Professional Services (max $20,000.00 <br />Account No. <br />251.0608.431.42.96 / 101.0608,431.31.06 <br />Amount <br />$46,780.00 <br />Terms of Contract <br />Not to Exceed <br />Purpose/Description <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />' <br />. Required For' Chan'ge Orelers Only <br />Amount of ❑ Incrr ease $ <br />❑ Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Kara Boyles <br />❑ ❑ <br />