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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />October 13. 2017 <br />Jacob M. Klosinski <br />Department Utilities Wastewater <br />Purchasing ® Carol Kurzhal <br />Check the Appropriate ltem 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. ® CIO & PCA No. 3, Final ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />n Other: <br />iKequirea intormation <br />Company or Vendor Name <br />HRP Construction, Inc. <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEMIBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Calvert Street Lift Station Replacement <br />Project Number <br />116-053 <br />Funding Source <br />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 Board of Public Works <br />approval of Change Order No. 3 which includes unit price <br />adjustments (underruns, deducts) and adjustments for temporary <br />Amount of <br />" Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment, E-Verifv. [ran. etc. <br />Increase $ <br />Decrease $ 4,319.75 <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />$ 920,608.20 <br />-0.47% <br />$ 916,288.45 <br />-0.07% <br />Dispersal After Approval <br />Al Greek, Director of Utilities <br />Jacob M. Klosinski, Assistant City Engineer <br />Carol Kurzhal, Director of Financial Services, Environmental Services <br />