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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 6, 2011 Department C &ED <br />BPW Date December 22, 2011 Phone 235 -5842 <br />Name Bill Schalliol <br />o Legal ® Attorney Name L. Meteiver <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ® and greater than one year in length per the City Purchasing <br />ti m Policy <br />Other Appropriate Reviewers ❑ <br />tequirsd [riform'a #sort <br />Company or Vendor Name <br />Agreement <br />Contract Proposal <br />$ <br />Addendum <br />Lj If Yes, Approved by Purchasing <br />Claim <br />Fellows Street Corridor Improvement Project - Supplement #1 <br />Project Number <br />Bid Opening <br />Funding Source <br />Award <br />Re . to Advertise <br />Title Sheet <br />Amount <br />Quote Opening <br />Terms of Contract <br />Quote Award <br />Purpose /Description <br />Ch Order No. <br />Proiect, Phase 2 <br />C/O & PCA No. <br />PCA <br />Ease. /Encroach. <br />7 <br />Traffic Control <br />LJ <br />Resolution <br />Other: <br />tequirsd [riform'a #sort <br />Company or Vendor Name <br />Christopher B. Burke Engineering <br />New Vendor <br />$ <br />Yes N No <br />Lj If Yes, Approved by Purchasing <br />Project Name <br />Fellows Street Corridor Improvement Project - Supplement #1 <br />Project Number <br />Not yet assigned) <br />Funding Source <br />SSDA TIF <br />Account No. <br />430 -1050- 460 -31.06 <br />Amount <br />$ 185,000.00 <br />Terms of Contract <br />Purpose /Description <br />Design service proposal for Fellows Street Corridor Improvement <br />Proiect, Phase 2 <br />Amount of <br />❑ <br />Increase <br />Decrease <br />$ <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />... <br />e.. A <br />:. is!�.Vgpoi <br />... <br />Copy <br />Original <br />❑ <br />® <br />Jason Durr, CBBE <br />® <br />❑ <br />Bill Schalliol, CED <br />