Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 19, 2016 <br />Name Jacob M. Klosinski Department Div. of Env. Services <br />BPW Date September 27, 2016 Phone Extension (574) 235-9496 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® Carol Kurzhal <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Greeley and Hansen, LLC <br />J Yes ZJ No U If Yes, Approved by Purchasing <br />J MBE ❑ WBE <br />W WTP - Digester Gas Utilization <br />116-050 <br />Wastewater <br />$ 5,500.00 (Credit) <br />The Division of Utilities requests the Board of Public Works approval of <br />Amendment No. 1 for the subject project for adjustments in the scope of <br />work resulting in a $5,500.00 credit. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment E-Verify, Iran etc.) <br />Required For Chance Orders Only <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />Al Greek <br />Jacob M. Klosinski <br />Carol Kurzhal <br />Approval <br />