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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 4 2020 <br />Department <br />Name Jacob M. Klosinski En inccrin /Utilities <br />BPW Date Februwar l l (! Phone Extension Ext. 9496 <br />Diversity Compliance <br />® <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney <br />Attorney Name <br />Dept. Attorney <br />Z <br />Attorney Name <br />Purchasing <br />® <br />Michael Schmidt <br />❑ Professional Services Agreement ❑ Contract <br />Michael Patton <br />Clara McDaniels <br />Clara McDaniels <br />Open Market Contract <br />® <br />Amendment/Addendum <br />El <br />Bid Opening <br />❑ <br />Bid Award <br />Quote Opening <br />❑ <br />Quote Award <br />Proposal Opening <br />F-1 <br />C/O & PCA No. <br />[] <br />Chg. Order, No. <br />F] <br />Traffic Control <br />n Other: <br />Company or Vendor Name A&Z Engineering, LLC <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />LJ Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />E] PCA <br />Resolution <br />Ease./Encroach <br />U Yes U If Yes, Approved by Purchasing <br />PAN <br />❑ Title Sheel <br />❑ WBE Completed E-Verify Form Attached Nos <br />US 2.............. .... <br />TBD <br />TII River West A,,zport or Other Accounts (to be determined) <br />324-1050-460-31-02 or Other Accounts to be determined <br />__.-.................-.-._._____ <br />$20,200.00 (Increases Total Contract to $127,600.00) <br />Lump Sum <br />The Division of Engineering requests the Board of Public Works a rpp oval i <br />the Amendment No. 2 to a Professional Services A reement with A&Z <br />Engineering for additional engineering services to desi n a water main <br />Increase $ <br />Decrease ($ <br />............. ....._......................................................... <br />.. <br />Increase % <br />C.....................__.__._._______ <br />Decrease _IT%._ <br />Increase % <br />_...._...._._. .................................... <br />Decrease ( /o <br />New Completion Date: <br />