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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />October 16, 2017 <br />Jacob M. Klosinski <br />Department Utilities Wastewater <br />BPW Date October 24, 2017 Phone Extension (574) 235-9496 <br />Re wired Prior to Submittal to Board <br />Legal ® Attorney Name Catherine Fanello <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 />U Agreement <br />U Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ® PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />l-1 <br />Other: <br />Company or Vendor Name EFM Excavating, Inc. <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Wastewater Treatment Plant Riverbank Stabilization - Phase 1 <br />Project Number nIa <br />Funding Source Utilities, Wastewater, Contractual Services Other <br />Account No. 641-0630-793-63-35 <br />Amount $ <br />Terms of Contract -Lump Sum <br />Purpose/Description The Division of Utilities recommends the Board of Public Works <br />approval of the Project Completion Affidavit for the Wastewater <br />Treatment Plant Riverbank Stabilization - Phase 1 project. Final <br />Project Cost $89,650.00. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Nan -Debarment, E-Verifv, Iran, etc.) <br />Amount of ❑ increase <br />❑ Decrease <br />Previous Amount <br />4 <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <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 />