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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/13/2020 <br />Name Leslie Biek Department Engineering <br />BPW Date 11/24/2020 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer Officer Name <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing Ron O’Connor <br />Check the Appropriate Item Type – Required 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. 6 Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name Rieth Riley <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor MBE <br /> WBE Completed E-Verify Form Attached Yes <br /> No <br />Project Name Corby Ironwood Rockne Intersection Improvement <br />Project Number 116-034 <br />Funding Source Major Moves <br />Account No. Fund 412 <br />Amount $922.22 <br />Terms of Contract Unit Price <br />Purpose/Description This change order is for the repair of a sprinkler line at 765 Country Club <br />Lane that was damaged during construction. Sprinkler repair was not included <br />as an item in the bid. This change order will not be federally reimbursed and <br />will be 100% locally funded. ___________________________ <br />For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ 922.22 <br />($ ) <br />Previous Amount $ 3,176,582.47 (original contract price $3,135,729.00) <br />Current Percent of Change: <br />Increase <br />Decrease <br />1.30% <br />( %) <br />New Amount $ 3,177,504.69 <br />Total Percent of Change: <br />Increase <br />Decrease <br />1.33% <br />( %) <br />Time Extension Amount: <br />New Completion Date: