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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 13, 2020 <br />Department <br />Name Jacob M. Klosinski EnOneerim/Utilities <br />BPW Date November 24, 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 />❑ 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. ❑ Traffic Control ❑ Resolution <br />171 Other: Agreement with AEP ❑ Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Information <br />American Electric Power 1 <br />/ Indiana Michigan Power <br />Yes ❑ If Yes, Approved by Purchasing <br />No <br />❑ ❑ <br />MBE Completed E-Verify Form Attached ❑ Nos <br />Wastewater Treatment Plant Electrical Improvements <br />117-132 <br />Funding Source Sewage Works Operations, Repairs and Maintenance -Building, R&M <br />Account No. 641-06-605-514-436001 (PR-00005428) <br />Amount $ 15,532.35 (Agreement I = $4,359.28; Agreement 2 = $11,173.07) <br />Terms of Contract Lump Sum, refer to Agreements <br />Purpose/Description Contribution -in -Aid of Construction Agreements for the installation of new <br />primary service feed, transformer relocation, and transformer removals. Refer <br />to Memorandum and Agreements for details. <br />� For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />Decrease <br />Increase <br />Decrease <br />