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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 09-19-2022 <br />Name: Jacob M. Klosinski Department of Public Works – Engineering Division <br />BPW Date: 09-27-2022 Phone Extension:9496 <br /> <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney Attorney Name Michael Schmidt <br /> <br />Purchasing Michael Schmidt <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. Traffic Control Resolution <br /> Other: Ratify Contracted <br />Emergency Work <br /> Ease./Encroach <br />Required Information <br />Company or Vendor Name Selge Construction Company, Inc. (V-00001471) <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 Emergency Repair – Napoleon Boulevard Sewer Repair <br />Project Number <br />Funding Source 641-06-602-509-439001 <br />Account No. PO-0018024 <br />Amount Original Estimate $25,000.00; Final Cost: $23,519.23 <br />Terms of Contract Lump Sum (T&M) <br />Special Contract Provisions None <br />Purpose/Description City Engineering and Streets/Sewer, contracted Selge Construction to provide <br />emergency repairs at Napoleon Boulevard after a sanitary sewer lateral and <br />sewer collapse. See Memorandum for description of services. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br />% <br />(%) <br /> New Amount $ <br />Total Percent of Change: <br />Increase <br />Decrease <br />% <br />(%) <br /> Time Extension Amount: <br />New Completion Date: <br />