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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />January 10, 2018 <br />Jacob M. Klosinski <br />Department Utilities Wastewater <br />Purchasing ® <br />*AI Greek, Director of Utilities* <br />T <br />Check the AppropriatO Item pe -Required for All Submissions <br />❑ Agreement <br />❑ Contract ❑ Proposal Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />® Change Order No. 17 <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />❑ Other: <br />R wired Information <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 />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 />2018 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. 17 which includes additions to the scope of work as described <br />in the attached Inter -Office Memordandum and Change Order <br />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 ® Increase $ 9,051.00 <br />❑ Decrease $ <br />Previous Amount <br />$ 13,939,218.47 <br />Current Percent of Change: <br />+0.08% <br />New Amount <br />$ 13,948,269.41 <br />Total Percent of Change: <br />+17.36% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Al Greek, Director of Utilities <br />® ❑ Jacob M. Klosinski, Assistant City Engineer <br />® ❑ Director of Financial Services, Environmental Services <br />