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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 />Purchasing <br />® Carol Kurzhal <br />Department Utilities Wastewater <br />❑ Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />® <br />Change Order No. 15 <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />❑ Other: <br />Company or Vendor Name <br />Thieneman Construction, Inc. <br />New Vendor <br />0 Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE 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. 15 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 $ 1,750.00 <br />Previous Amount $ 13,921,615,47 <br />Current Percent of Change: -0.02% <br />New Amount $ 13,919,865.47 <br />Total Percent of Change: +17.12% <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <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 />