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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/19/2016 <br />Name Chris Dressel <br />Department Community <br />Investment <br />BPW Date 7/26/16 Phone Extension 5847 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Ben Dougherty <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />® Agreement ❑ Contract ❑ Proposal ® Addendum <br />Q Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I-1 Other: <br />Required Information <br />Company or Vendor Name Toole Design Group LLC <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBENVBE Contractor ❑ MBE ❑ WBE <br />MBENVBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name City of South Bend Bike Share Feasibility Study/Business Plan <br />Project Number Sustainability Office 2016 Budget <br />Funding Source C-4 <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />222-0616-419-31.06 <br />30,900 <br />8/2014 — 12/31/16 <br />Addendum as request to increase contract funding amount for bike <br />share study <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of N Increase -❑ Decrease <br />Previous Amount $ 2( <br />Current Percent of Change: N/A <br />New Amount <br />Total Percent of Change <br />Copy <br />Original <br />El <br />X <br />❑ <br />❑ <br />N/A <br />N/A <br />fired For Change Orders On <br />30,900 <br />M <br />Dispersal After Approval <br />DC] — Chris Dressel <br />Toole Design Group <br />