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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />February 20, 2017 <br />Scott Horvath <br />Department Utilities- Water <br />BPW Date February 28, 2017 Phone Extension 5665 <br />Required Prior to Submittal to Board <br />Legal x Attorney Name Michael Schmidt <br />Controller x 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 x <br />Check the Appropriate Item Type — Required for All Submissions <br />x 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 />Other: <br />uired I <br />Company or Vendor Name Midwest Meter <br />New Vendor ❑ Yes x No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Meter Replacement <br />Project Number <br />Funding Source Water Works Operating Fund <br />Account No. 620-0640-658-37-11 and 620-0640-658-37-12 <br />Amount $ 960,000 <br />Terms of Contract Until 12/31/17 <br />Purpose/Description Extend price to replace meters as necessary until next generation <br />system is in place <br />x Required Contractor's Certification Form Attached (Non -Collusion, <br />Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />❑ x Roxanne Lawson <br />x ❑ Kim Thompson <br />x ❑ Scott Horvath <br />