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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 5, 2018 <br />Name Jacob M. Klosinski <br />Department Utilities - Wastewater <br />BPW Date November 8, 2018 A enda Meeting Phone Extension (574) 235-9496 <br />Ol�lllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllmllll �IWXI ff+W'mrna2-c-c-c-arzu�sg:. rrrscru w , --q,' ;�WkSNXSW PG ..v..v..v...wl uUi¢�5d4..'„23"PvryG �. <br />Re uired Prior to Submittal toBar�� <br />Legal Attorney Name Clara McDaniels Assistant City Attorney <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the P <br />J_j Agreement <br />❑ Professional Services <br />n Bid Opening <br />F-1 Quote Opening <br />❑ Chg Order No. <br />F] Ease./Encroach. <br />r_1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />AI Greek. Director of Utilities <br />iropriate Item Type—wRequired for All Submissions <br />Contract Proposal ❑ Addendum <br />I_J Amendment <br />Bid Award ® Req. to Advertise ❑ Title Sheet <br />El Quote Award <br />El C/O & PCA No. ❑ PCA <br />El Traffic Control El Resolution <br />0 Claim <br />ea fired Information <br />❑ Yes _ _.,..: .....I.f... Yes, <br />....Approved"by....Purchasing ............... <br />❑ No <br />WBECompleted E-Verify Form Attached � Nos <br />WWTP Raw Sewa e Pump o No. 2 Rehabilitation ........................w <br />118-020 <br />Utilities Sewage Works Capital, Treatment & Disposal Equip. <br />mm � �e <br />642-0630-415-43-66 <br />Purpose/Description The Division of Utilities is reguesting the Board of Public Works <br />approval of reguest to advertise for the receipt of bids for the <br />subject Project. Advertise on 11/09/2018 and 11/16/2018. See <br />Inter -office Memorandum for oroiect descrir)tion <br />..,._._.e.,m..._....�—.......�����.....:..For wChan <br />� Orders <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change <br />Time Extension: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />Dispersal After Approval <br />Al Greek, Director of Utilities <br />Jacob M. Klosinski, Assistant City Engineer <br />Susan Zee b, Director of Wa__,t... <br />e �� lwives <br />stewater Financial Services <br />