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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 4 2019 <br />Department <br />Name Jacob M. Klosinski Engineerm^ / Utilities <br />BPW Date November 12 2019 Phone Extension Ext. 9496 <br />wwwmeme ommmmmm�o morvr�ummiNpmrau�urereamrnp!nip m=m M <br />Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />�_............����.............................�..........._....w _. <br />PurchasingEl <br />Check the Appropriate Item Type <br />Professional Services Agreement QJ Contract <br />E] Open Market Contract <br />El Amendment/Addendum <br />❑ Bid Opening <br />[] Bid Award <br />F Quote Opening <br />El Quote Award <br />Proposal Opening <br />C/O & PCA No. <br />El Chg. Order, No. <br />Traffic Control <br />Other: <br />R..._Information <br />Information <br />._........................_................... <br />All Submissions <br />Proposal <br />LJ Special Purchase, QPA <br />E] Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />Company or Vendor Name EFM Exc,avatin, Inc ....._._ <br />New Vendor -0—WT1 If Yes, Approved by Purchasing <br />® No <br />MBE/WBE Contractor ❑ MBE Completed E-Verify Form Attached Nos <br />Project Name Wastewater Treatment Plant Riverbank Stabilization - Phase 2 <br />. <br />... <br />.................. ____.mw�. _�........�w ........ <br />Project Number <br />Funding Source Utilities, Wastewater, Other Equipment. <br />Account No. 641-0630-793-36-05 <br />$99,__....................................m <br />650 <br />Amount 00 <br />Terms of Contract Lump Sum Not to Excee <br />d <br />Purpose/Description The Division of EngineeringEpgineering and Utilities requests approval of the Project <br />ComL)Ietior A1'llday.it fo.r tl e sttb'ect rca"ett_...EFM Excavating com2leted <br />work. Final Project Cost $99 650.00.. Project Completion Affidavit attach( <br />For Cltartc Orders trl_:_. <br />Increase $ <br />Amountof ...�___.....__.._m �.______ �....._..._ .. ...._.. w...w_.r. <br />Decrease ($ ).......... <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />% <br />New Amount <br />$ <br />Increase <br />/o <br />Total Percent of Change: <br />Decrease <br />( % <br />Time Extension Amount:.... <br />New Completion Date: <br />