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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date6/30/2020DepartmentPublic Works <br />Name Sue Ellen DoudrickDivision/Bureau Engineering <br />BPW Date 7/14/20 Phone Extension 5992 <br /> <br />Required Prior to Submittal to Board <br />LegalAttorney Name: Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more and <br />Controller <br />greater than one year in length per the City Purchasing Policy <br /> Purchasing Michael Schmidt <br />Check the Appropriate Item Type –Required for All Submissions <br />AgreementAmendmentContractProposalAddendum <br />Professional Services Resolution <br />Bid Opening Bid Award Req. to Advertise Title Sheet <br />Quote Opening Quote Award <br />Change Order No. 1 C/O & PCA No. PCA <br />Ease/Encroach. Traffic Control: <br />Other: <br />Required Information <br />Company or Vendor Name Inland WatersPollution Control <br /> Yes No If Yes, Approved by <br />New Vendor Purchasing <br />MBE/WBE Contractor MBE WBE <br />MBE/WBE Contractor Requested No Yes Name of Company <br />Project Name Sewer and Manhole Rehabilitation <br />Project Number 118-093 <br />Funding Source Sewer: services & charges – other – other contractual services <br />Account No. <br />641-06-602-509-439001 <br />1. Change Order #1: $70,378.00 <br />Amount <br />Terms of Contract Unit prices <br />Purpose/Description <br />Emergency Sewer Lining required at Western Avenue <br />See attached change order documentation. <br />Required Contractor’s Certification FormsAttached(Non- <br />Collusion, Non-Discrimination, Non-Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />$ 70,378.00 <br /> Increase <br />Amount of <br /> Decrease$ <br />Previous Amount $ 3,124,276.50 <br />Current Percent of Change: 2.25% <br />New Amount $3,194,654.50 <br />Total Percent of Change: 2.25% <br />Dispersal After Approval <br />Copy Original <br /> <br /> <br /> <br /> <br />