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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />August 11, 2017 <br />Jacob M. Klosinski <br />Department Utilities Wastewater <br />BPW Date August 22, 2017 Phone Extension (574) 235-9496 <br />Requited Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />® Carol Kurzha <br />Check the Appropdate'Item Type- Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />® Change Order No. 14 ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />n Other: <br />Company or Vendor Name <br />Thieneman Construction Inc. <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEMIBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Wastewater Treatment Plant Secondary Treatment Improvements <br />Project Number <br />114-053 <br />Funding Source <br />2017 Wastewater Capital Account <br />Account No. <br />642-0630-415-43-66 <br />Amount <br />$ <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. 14 which includes additions and deductions to the scope of <br />work as described in the attached Inter -Office Memordandum and <br />Change Order Documents. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of ❑ Increase $ <br />® Decrease $ 66,489.40 <br />Previous Amount $ 13,988,104.87 <br />Current Percent of Change: -0.56% <br />New Amount $ 13,921,615.47 <br />Total Percent of Change: +17.14% <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 />