Change Order-PCA - WWTP Primary Clarifier Rehab & Equip Upgrades - L.D.Docsa

Home Browse Search

BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 09/02/2016 Name Jacob M. Klosinski Department Utilities - Wastewater BPW Date 09/13/2016 Phone Extension (574) 235-9496 Required Prior to Submittal to Board Legal ® Attorney Name Michael Schmidt Controller ® Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ® Carol Kurzhal 1`" [\ L"C ^NNIV Iicuc nci 11 I ypv — rxyqu1ruu /u/ H❑ ouomissions ❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum ❑ Professional Services ❑ Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Change Order No. ® C/O & PCA No. 007 ❑ PCA ❑ Ease/Encroach. ❑ Traffic Control n Other: Company or Vendor Name L.D. Docsa Associates Inc. New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name WWTP - Primary Clarifier Rehabilitation & Equipment Upgrades Project Number 111-071 Funding Source Wastewater Capital and 2012 Sewer Bond Account No. 642-0630-415-43-66 (Canitan 661-nF10-d1 s_d*:)_na rco,.,o� R r� Amount $ 5,110,540.51 Terms of Contract Purpose/Description Amount of Proiect Closeout Documents ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran, etc Increase $ Decrease $ Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ® ❑ ® ❑ ® ❑ -0.79% $ 5,110,540.51 1.33% Dispersal After Approval Al Greek, Director of Utilities Jacob M. Klosinski- Assistant Citv Fnninper Carol Kurzhal, Director of Financial Services, Environmental Services