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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1 2/18/2018 <br />Name Kieran Fah Department Public Works <br />......_ <br />BPW Date 12/20/2018 Phone Extension 59m93mm <br />��muuuuuumummuwmmwuumwwwwwwwwwwwwuuw�.wmuvw�vxx�nn � r�uuw;w wwomomommrvrwm�wmmu�urmmmmm.��wuux , mr�ama,�.... v� <br />-..... <br />_......_ <br />......_ _ <br />Required Prior to Submittal to Board <br />Legal <br />_ <br />Attorney Name <br />Controller ❑ <br />Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />.� Check the A <br />ro ria t Item Type -- leqyir�d° for All Submissions <br />Agreement❑Contract <br />(❑ Proposal E I Addendum <br />® Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />El <br />Quote Award <br />❑ Change Order No. <br />[l <br />C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />E Traffic Control <br />[❑ Other: <br />_....... <br />Required Information <br />__.............._... _ _...... .... _ ..._ <br />Company or Vendor Name: Stantec Consulting Services <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE [❑ <br />WBE <br />MBE/WBE Contractor Requested ❑ No❑ Yes Name of Company <br />Project Name <br />LTCP oConstruction reporting obligations <br />� �... truw ,. � ....n Monit.m._���� <br />Project Number <br />117-056�tmmCons <br />Funding Source <br />m�...._..,. <br />Wastewater Professionalo_................ ....� <br />Services En ic,�'neering (LTCP) <br />Account No. <br />641�-0630-793-31-02 <br />Amount <br />...�................�w � ... .... ....._.�_r m�..... __. <br />69,995 Not to exceed <br />Terms of Contract <br />Purpose/Description <br />onser t Decree "eporting on Post Construction. <br />[� Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination Non -Debarment, E-Verify, Iran, etc. <br />Required For Change Orders Only.... <br />. ...... . <br />Amount of 0 Increase $ <br />❑ Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />�- � � .�.�.�. �_ ...... � <br />% <br />New Amount <br />...............__�.............................. __�..� .............. ..................................................aaaada.a................................�.�..��_. <br />$ <br />Total Percent of Change: <br />....................... _.... <br />Dispersal After Approval <br />Copy Original <br />0 El <br />