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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />December 6, 2016 <br />Department Division of Utilities <br />BPW Date December 13, 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 $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Jacob M. Klosinski <br />Purchasing ® <br />Carol Kurzhal <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />® Change Order No. 006 <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />I -I Other: <br />Company or <br />Thieneman Construction, Inc. <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />Project Name <br />WWTP - Secondary Treatment Improvements <br />Project Number <br />114-053 <br />Funding Source <br />2011 Sewer Bond and 2012 Sewer Bond <br />Account No. <br />659-0630-415-42-06 (2011 Bond) and 661-0630-415-42-06 (2012 Bond) <br />Amount <br />$ Change Order, see below <br />Terms of Contract <br />Lump Sum, Quantities <br />Purpose/Description <br />Division of Utilities recommends the approval of Change Order No. 6 for <br />the subject project. Refer to Inter -Office Memorandum and enclosures for <br />description of changes (additions and delays due to unforeseen conditions). <br />Addition of 13 Calendar Days to Substantial and Final Completion. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of ® <br />Increase $ 90,690.00 <br />❑ <br />Decrease $ <br />Previous Amount <br />$ 12,653,675.87 <br />Current Percent of Change: +0.76% <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />Al <br />+7.23 % <br />Dispersal After Approval <br />Division Director of Utilities <br />Jacob M. Klosinski, <br />Carol Kurzhal, Director of Financial Services, Environmental Services <br />