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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/22/2020 <br />Name Zach Hurst Department DPW <br />BPW Date 04/28/2020 Phone Extension 3057 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Type — Re uired or All Submissions <br />® Professional Services Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Ciorba <br />❑ Yes <br />71 No <br />Information <br />If Yes, Approved by Purchasing <br />❑ WBE Completed E-Verify Form Attached ❑❑ Yes <br />No <br />Southern Gateway Bridge Beautification Project <br />120-008 <br />Engineering Professional Services <br />101-0602-431.31-06 <br />Amount $12,095 <br />Terms of Contract Lump Sum <br />Purpose/Description Design services for aesthetic improvements to the bridge replacement project <br />for the US 20 ByPass over Michigan Street. Contact is Brett W. Sauter <br /><bs auter(a, Ciorba. com>. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Combletion Date: <br />Increase <br />Decrease <br />Increase <br />Decrease <br />