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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 30, 2020 <br />Department <br />Name Jacob M. Klosinski EnOneerim/Utilities <br />BPW Date November 10, 2020 Phone Extension Ext. 9496 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name Michael Patton <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ <br />Purchasing ❑ <br />Check the <br />Clara McDaniels <br />Attorney Name Clara McDaniels <br />Michael Schmidt <br />to Item Tvbe — Reauired for All Submissions <br />U Professional Services Agreement U Contract U 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. 1-Final ❑ PCA <br />❑ Chg. Order, No. 1 - Final ❑ 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 />Information <br />Inc. <br />If Yes, Approved by Purchasing <br />❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />Miami Basin Control Valve Replacement <br />116-082D <br />LRSA Canital and South Side TIF <br />251-06-600-506-442001 and 430-10-102-121-444000 <br />$ See Below <br />Terms of Contract LumD Sum and Unit Prices <br />Purpose/Description The Division of Engineering and Division of Utilities recommends the Board <br />of Public Works approve Change Order No. 1 and the Project Completion <br />Affidavit for the subject project. Refer to Memorandum for additional details. <br />� For Change Orders Only <br />Amount of ❑ Increase $ <br />® Decrease ($ 740.52) <br />Previous Amount $ 176,000.00 <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease 0.42% <br />$ 175,259.48 <br />Increase % <br />Total Percent of Change: Decrease 0.42% <br />Time Extension Amount: 0 Days <br />New Completion Date: No Change <br />