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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/21/2020 <br />Name Becca Plantz Department Public Works <br />BPW Date 7/28/2020 Phone Extension 5998 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name Michael Patton <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 />Information <br />Jones Petrie Rafinski Corrooration <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />E] MBE ❑ WBE Completed E-Verify Form Attached ❑ Yes <br />❑ <br />On -Call Survev/Right-of-Wav Services <br />118-065 <br />$10,000 Engineering Professional Services, $11,500 Stormwater Professional Services <br />101-06-600-500-431000, 667-605-517-431000/667-605-517-431002 <br />Amount $21,5000 (Orig.: $10,000 Amend 1: $6,000 New Total: $37,500) <br />Terms of Contract Hourly Not to Exceed <br />Purpose/Description Amendment 2 to On -Call Survey/Right-of-Way Services for additional <br />locations. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Increase % <br />Decrease ( % <br />Increase % <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />New Combletion Date: <br />