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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />November 5, 2018 <br />Jacob M. Klosinski <br />Department Utilities - Wastewater <br />BPW Date November 13, 2018 Phone Extension (574) 235-9496 <br />uah�,:x�ti�nrw,ruava� dr ,�....--� �an�,«ur.�:�„n:dda e�n�a ;.. ;�ne!�.� ,., zau��a s^.�:w^:a�aar• �wnnu,rv:�roarvw,; . rd�,,.waww��. <br />.._,..... _. ,. Re u <br />....... �..... to ...... ...... .._.._, .,....m. <br />.,...... _ w�.._ _ o Board fired Prior to Submittal t <br />Legal Attorney Name Clara McDaniels Assistant Citv Attorney <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller Z and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing Z Al Greek Director of Utilities <br />Check the <br />❑ Agreement <br />El Professional Services <br />E] Bid Opening <br />F-1 Quote Opening <br />E] Chg Order No. <br />❑ Ease./Encroach. <br />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 />crop iat Item Tempe_— <br />Contract <br />Amendment <br />All Submissions <br />Proposal <br />E] Bid Award ® Req. to Advertise <br />El Quote Award <br />C/O & PCA No. ❑ PCA <br />❑ Traffic Control Q' Resolution <br />Claim <br />Required.. Information W..._ <br />Addendum <br />® Title Sheet <br />�..E]_��.................... , If YesApproved... Purchasing by mm mm.....,.,........................................................... <br />Yes Purchf <br />No <br />El MBE Completed E-Verify Form Attached El Yes <br />[ ] WBE No <br />WWTP Administration Building Masonry Improvements <br />118-087 <br />Sewa e W. <br />orks Operations, Building Repairs &Maintenance <br />641-0630-793-36-01 <br />Purpose/Description The Division of Utilities is requesting the Board of Public Works <br />approval of Reguest to Advertise and Title Sheet for the receipt of <br />bids for the sub'ect proiect. Advertise on 11/16/2018 and <br />11/23/2018. See Inter -office Memorandum <br />randum for project description <br />.. _ �........_ _�..�.....� For Chan On�_.. .. ..:_..:�� <br />�..�... ... ly...�� .............. �.�dr <br />Amount of Increase $ <br />Decrease $ <br />Previous Amount $ <br />g <br />Current Percent of Change- % <br />New Amount $ <br />TotalPercent of Change: �._����_�.����_�%._.......m..........................................�w��..._—....A,........�................................................. �a ���.�..�. <br />m.__.................................................................. ._ _.....,.................................��......���.—. _..... <br />Time Extension: _ <br />Dispersal �.......��..........._�� <br />After Approval <br />Copy Original <br />® Al Greek, Director of Utilities <br />® ❑ Jacob M. KlosinskiAssistant City Engineer ® El Susan Zeeb, Director of Wastewater Financial Services <br />