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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date _November 15, 2018 <br />Name Becca Plantz..................� <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date November 27, 2018 Phone Extension 5998 <br />IW Ifl MmVMtl NNI!NWINNNNNPAWINVMWq!A mmmmmmmmmmWmfl ImP mW@MN <br />..W .. <br />..._...._.._.e _Re Prior to Submittal to Board uired <br />Legal ❑ Attorney Name: Clara McDaniels <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 ❑ Michael Schmidt <br />Check the <br />[] Agreement Amendment <br />❑ Professional Services <br />E] Bid Opening <br />Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />F Other: <br />Company or Vendor Name <br />)ropriate Item Type - <br />El Contract <br />Resolution <br />Bid Award <br />Quote Award <br />FC/O &PCANo. <br />F Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of LJ Increase <br />Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />for All Submissions <br />] Proposal <br />❑ Req. to Advertise <br />ired Information <br />Peerless Midwest <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />El Yes No ❑ If Yes, Approved by <br />Purchasing <br />MBE [] WBE <br />No El Yes Name of Compaq <br />Olive Production Well #6 Rehabilitation ._...............m <br />118-102 <br />wwwwwwwwww,,,...................... <br />_.. <br />Water Works O & M <br />_......__.......... ww_.... .................. ............... ... <br />620-0640-602-31-06 <br />$50,930.00 <br />Lump Sum <br />e cleaning and ins ec�ion of well #6 at the Oliver <br />Well Field. <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />equired For Change Orders Only <br />Disraersal After <br />Becca Plantz <br />.............. <br />Bradlev VanOosterum <br />