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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 20, 2017 <br />Name Jacob M. Klosinski Department <br />Utilities Wastewater <br />BPW Date March 28, 2017 Phone Extension (E 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 <br />® Carol Kurzhal <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. 8 ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />F] Other: <br />Company or Vendor Name Thieneman Construction Inc <br />New Vendor ❑ Yes ® 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 Wastewater Treatment Plant Secondary Treatment <br />Project Number 114-053 <br />2011 Sewer Bond, 2012 Sewer Bond, Wastewater Equipment <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Previous Amount <br />Purchases / Treatment and <br />659-0630-415-42-06(2011 Bond); 661-0630-415-42-06 (2012 <br />Bond):642-0630-415-43-66 <br />nts <br />Lump Sum and Unit Prices <br />The Division of Utilities recommends the Board of Public Works <br />approval of Change Order No. 8 which reflects necessary changes <br />or additions to the scope of work (see attached Inter -Office <br />Memorandum for Details). <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Increase $ 228,905.00 + 37 Days to Substantial & Final <br />Decrease $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />$ 12,790,965.87 <br />+1.93% <br />$ 13,019,600.87 <br />Dispersal After Approval <br />AI Greek, Director of Utilities <br />Jacob M. Klosinski, Assistant City Engineer <br />Carol Kurzhal, Director of Financial Services, Environmental Services <br />