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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />December 18, 2017 <br />Jacob M. Klosinski <br />Department Utilities Wastewater <br />❑ Agreement <br />Ll Contract Lj Proposal U Addendum <br />❑ Professional Services <br />❑ <br />Resolution <br />❑ Bid Opening <br />❑] <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />® <br />Change Order No. 16 <br />❑ CIO & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />❑ <br />Other: <br />':-'1:\G Nll 6.l4::1[1[VI[llii LAVAA .. <br />Company or Vendor Name Thieneman Construction,_ Inc. <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE Contractor <br />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. 16 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-Verify, Iran, etc. <br />Required For Change Orders Only <br />Amount of ® <br />Increase $ 19,353.00 <br />❑ <br />Decrease $ <br />Previous Amount <br />$ 13,919,865.47 <br />Current Percent of Change: +0.16% <br />New Amount <br />$ 13,939,218.47 <br />Total Percent of Change: +17.28% <br />Dispersal After Approval <br />Copy Original <br />® ❑ <br />Al Greek, Director of Utilities <br />® ❑ <br />Jacob M. Klosinski, Assistant City Engineer <br />® ❑ <br />Carol Kurzhal, Director of Financial Services, Environmental Services <br />