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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/15/2020 <br />Name Leslie Biek Department Engineering <br />BPW Date 10/27/2020 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ® Ron O'Connor <br />Check the Appropriate Item Type — Re uired or All Submissions <br />❑ Professional Services Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />® Chg. Order, No. 2 & 3 ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Information <br />Rieth R <br />U Yes U If Yes, Approved by Purchasing <br />® No <br />E] MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />Corby Ironwood Rockne Intersection Improvement <br />116-034 <br />LR&S Streets and <br />442001 <br />$26,932.70 <br />Unit Price <br />This change order is for the relocation of three (3) water meter vaults, water <br />valves and the addition of a 2" water service (CO #2 - $20,976.50) and for the <br />addition of ten (10) arborvitae around the newly created retention pond(CO <br />#3 - $5,956.20). Both of these change orders will not be federally funded. <br />They will be 100% locally funded <br />For Chanize Orders Onl <br />Amount of ® Increase $ 26,932.70 <br />❑ Decrease ($ ) <br />Previous Amount $ 3,135,729.00 <br />Increase .86% <br />Current Percent of Change: Decrease ( %) <br />New Amount $ 3,162,661.70 <br />Increase .86% <br />Total Percent of Change: Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />