Change Order No 1 & PCA - Erskine Well No. 2 Rehabilitation Proj No. 119-096 - Peerless Midwest, Inc.

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 02/25/2020 v Name To Villa _................... Department En ineerinng ........... ..................�_......._....... BPW Date 3/10/2020 Phone Extension 5920 Required Prior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney F-] Attorney Name Purchasing Check the Appropriate Item 1`yp ........................ ❑ Professional Services Agreement ❑ Contract F-1 Open Market Contract E] Amendment/Addendum F] Bid Opening f-1 Bid Award EJ Quote Opening El Quote Award ❑ Proposal Opening ❑ C/O & PCA No. 1(final) ❑ Chg. Order, No. ❑ Traffic Control Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose[Descri tat ( ui `ed Information All Submissions LJ Proposal El Special Purchase, QPA El Req. to Advertise Reject Bids/Quotes PCA Resolution Ease./Encroach Peerless Midwest [� Yes ❑ If Yes, Approved by Purchasing No MBE ❑ iv-DrCompleted E-Verify Form Attached Erskine Well #2 Rehabilitation 119-096 Water Works — Source of Sy2p 620.0640.602.31.06 .............................. ect Closeout For Chan e.Orders 0i 1 ❑ Title Sheet ❑ Yes ❑ No and Other Professional Services Amount of ❑ Increase $IT .. ..._............ ...... ® Decrease $2,600.00 ............. Previous Amount $ 64,000.00 Increase % ...... __........... Current Percent of Change: Decrease (4.00%) New Amount $ 62,000.00 _._._......._... ._- . ................... ._u �........_._ Increase % Total Percent of Change: Decrease (4.00%) Time Extension Amount: .................................................. ................. .. New Completion Date: