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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 6, 2017 <br />Name Jacob M. Klosinski Department Utilities Wastewater <br />BPW Date June 13, 2017 <br />Phone Extension (574) 235-9496 <br />Rego ired Prior to Submittal to Board <br />Legal ® <br />Attorney Name Michael Schmidt <br />Controller ® <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® <br />Carol Kurzhal <br />. Check the`A <br />ro riate ltbhi`T e 4 Required f&A11:SdbmJssJons <br />❑ Agreement <br />❑ Contract ❑ Proposal ❑Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award. ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />® Change Order No. 11 <br />❑ CIO & PCA No. ❑ PCA <br />❑ EaselEncroach. <br />❑ Traffic Control <br />❑ Other: <br />Re aired Information77771 <br />Company or Vendor Name <br />Thieneman Construction Inc. <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Wastewater Treatment Plant Secondary Treatment Improvements <br />Project Number <br />114-053 <br />2012 Sewer Bond, Capital Improvements Wastewater Treatment <br />Funding Source <br />Plant (subject to 3rd Quarter Appropriation) <br />Account No. <br />661-0630-415-42-06 <br />Amount <br />$ <br />Terms of Contract <br />Lump Sum and Unit Prices <br />Purpose/Description <br />The Division of Utilities recommends the approval of Change Order <br />No. 11 which includes necessa concrete work saw cutting, and <br />grating required but not detailed in the original scope of work. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Nan -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of ® Increase $ 31,550.00 <br />❑ Decrease $ <br />Previous Amount $ 13,468,684.87 <br />Current Percent of Change: 0.26% <br />New Amount $ 13,500,234.87 <br />Total Percent of Change: +13.59% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Al Greek, Director of Utilities <br />® ❑ Jacob M. Klosinski, Assistant City Engineer <br />® ❑ Carol Kurzhal, Director of Financial Services, Environmental Services <br />