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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 18, 2018 <br />Name Kyle Silveus <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date December 20, 2018 Phone Extension 9083 <br />wwrmmssmma r�® uuuuuuuuwuwwuwuwwim �rwarww,wmwro�iwv�wmmnu�m�.w wwwimu wwartm My �mPmuwMM99PR aerrvimm:rmfMprvrc ae ur:�ma�mnruva� <br />Required Prior to Submittal to Board <br />......m........ �..... . .......... _ _._.�...._ ........ ... . . <br />Legal ® Attorney Name: Clara McDaniels <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 El Michael Schmidt <br />Check the <br />LJ Agreement <br />El Professional Services <br />Bid Opening <br />Quote Opening <br />[] Change Order No. <br />Ease/Encroach. <br />Other: Contract Suoolement <br />iro riate Item Type — Required for All Submissions <br />El Contract Proposal <br />❑ Resolution <br />❑ Bid Award ❑ Req. to Advertise <br />Quote Award <br />C/O & PCA No. ❑ PCA <br />n Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Required Information <br />United Consulting_._. <br />ENG: 115-063 DES No: 1401810 <br />RiverwestTIF ..._................................................_�.... <br />324.1050.460.42.02 <br />mm Phase I: Increase of $28.45.5.............. <br />Addendum <br />❑ Title Sheet <br />Purchasi <br />Terms of Contract Total fee not to exceed <br />i <br />Scope additions include. Appra.���������. <br />Purpose/Description sal Problem Analysis (APA) <br />costs and Phase II Environmental assessment_ activities <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />ie�le For Change Orders Qal....._ ._.._..__ ..... <br />Amount of ❑ Increase $ <br />EI Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Charge: % <br />Disoersal After <br />Copy <br />Original <br />®n <br />Kyle Silveus <br />® <br />[l Chris Dressel <br />