Change Order No 1 - Four Winds Field Water Softener - Culligan Water

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 070?/2019 Name Patrick Sherman Department VPA BPW Date 070,G,(2019 Phone Extension 5601 _..._ ....... Pe quiredITPrior to Submittal to Board Legal Z Attorney Name Clara McDaniels Controller z Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing Z Michael Schmidt Check the Agreement 0 Professional Services (l Bid Opening ❑ Quote Opening ® Change Order No. 1 Ease/Encroach. Other: r " Contract F-1 Resolution ❑ Bid Award ❑ Quote Award ❑ C/O & PCA No. ❑ Traffic Control for All Submissions Proposal ❑ Req. to Advertise Required Information Company or Vendor Name Culligan of Mishawaka ❑ PCA Addendum ❑ Title Sheet New Vendor ❑ Yes ® No [J If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE E] WBE MBE/WBE Contractor Requested ❑ No F] Yes Name of Company Project Name Four Winds Field Water Softener Project Number 1083-20.1_9....._...�.................._�......_................�_�� ,...... �.._._..._.._....... Funding Source Non-reverti q Cove fund ...... _.�........__.-w Account No. 401-1101-452.36.09 Amount $ 14,620.00 Terms of Contract 30 days from NTP Purpose/Description Project Com letion Affidavit ................_ _.._.... Required Contractor's Certification Form Attached (Non- .._.. _ .�._ Collusion,E-Verify, Iran, Collusion,. Non -Discrimination, Non -Debarment, an, etc. �.....,_....v__ _ Re¢ rred For Chan _Orders Only Amount of ® Increase $ 1,295.00 El Decrease $ Previous Amount $ 13,325.00 —..._-....._._......_..............-.................. Current Percent of Change: 9.7% NewAmount - $ 14,620.00��.�..........m........�.�.�.�_�_..._.�m��_...........m �_..._............. Total Percent of Change: 9.7% Dispersal After Approval Copy Original F-1 El 1-1 El n ❑