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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />January 17. 2019 <br />Jacob M. Klosinski <br />Department Utilities Env. Serv, <br />BPW Date Februa 12, 2019 Phone Extension574235-9496 <br />!�'✓�✓� me�uar�mr� � ru a omomomo� eirm�n <br />........ ....�.�. .,.............. <br />..w....._.......... ......_ ........_.... <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® *AI Greek Director of Utilities* <br />Check the Appropriate Item Type <br />Agreement <br />Professional Services <br />Bid Opening <br />❑ Quote Opening <br />[:] Change Order No. <br />F-j Ease/Encroach. <br />0 Other: <br />LJ Contract <br />Resolution <br />Bid Award <br />Quote Award <br />® C/O & PCA No. 1 Final <br />❑ Traffic Control <br />for All Submissions <br />Q Proposal Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />❑ PCA <br />Company or Vendor Name Alfa Laval Houston Texas <br />New Vendor ❑ Yes ® No M If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ® Yes Name of Company See Contractor Bid <br />Project Name WWTP - Belt Filter Press #1 Rehabilitation <br />Project Number 118-019 <br />Funding Source Utilities - Wastewater ..................._w � .........._ ...... <br />astewater -Other Equipment <br />Account No. 641-0630-793-36-05 <br />Amount $ <br />Terms of Contract <br />Purpose/Description The Division of Utilities reguests the approval of closeout <br />documents Change Order No. 1 Final Project Completion <br />Affidavit and Maintenance Bond for the subject roject. Final Pro'ecl <br />Cost 02,956.00. <br />Ej Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify,Iran, etc.). <br />Rewired For Change Orders n!__....--- <br />Amount of El Increase $ <br />Decrease $ 175.00 <br />Previous Amount $ 203,1 .1.......0.....0. <br />Current Percent of Change:-0.0860/o <br />New Amount $ 202,956.00 <br />Total Percent of Change:-0.086% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Al Greek, Director of Utilities <br />® Jacob M. Klosinski, Assistant City Engineer <br />® Susan Zeeb, Director of Financial Services Wastewater <br />