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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />January 13, 2017 <br />Department Utilities Wastewater <br />BPW Date January 24, 2017 Phone Extension (574) 235-9496 <br />Jacob M. Klosinski <br />Kequired Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® Carol Kurzhal <br />Check the Appropriate Item Type — Required for AU Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />® Change Order No. 7 ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Information <br />Company or Vendor Name Thieneman Construction, Inc. <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEM/BE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Wastewater Treatment Plant Secondary Treatment Improvements <br />Project Number 114-053 <br />2011 Sewer Bond, 2012 Sewer Bond, Wastewater Equipment <br />Funding Source <br />Purchases / Treatment and Disposal <br />659-0630-415-42-06 (2011 Bond); 661-0630-415-42-06 (2012 <br />Account No. <br />Bond); 642-0630-415-43-66 <br />Amount <br />$ <br />Terms of Contract <br />Lump Sum and Unit Prices <br />Purpose/Description <br />Utilities recommends the Board of Public Works approval of Change <br />Order No. 7 which reflects necessary changes or additions to the <br />scope of work (see attached). <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 $ 46,330.00 <br />❑ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />® ❑ Al Gre <br />® ❑ Jacob <br />® ❑ Carol <br />$ 12,744,635.87 <br />+0.39% <br />$ 12,790,965.87 <br />+7.62% <br />After Approval <br />Director of Utilities <br />Klosinski, Assistant <br />!hal, Director of Fin; <br />I Services <br />