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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 10-18-2022 <br />Name: Jacob M. Klosinski Department of Public Works – Engineering Division <br />BPW Date: 11-08-2022 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 – Notre Dame Avenue and Howard Street San. Sewer <br />Project Number <br />Funding Source 641-06-602-509-439001 <br />Account No. PO-0018540 <br />Amount Original Estimate $50,000.00. Final Cost: $73,261.47 <br />Terms of Contract Lump Sum (T&M) <br />Special Contract Provisions None <br />Purpose/Description City Engineering and Streets/Sewers, contracted Selge Construction to <br />provide emergency repairs at Notre Dame Avenue and Howard Street after <br />undermining and a sewer collapse were identified by City Sewer crews. See <br />Memorandum for description of services and repair work. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br />% <br />(%) <br /> <br />New Amount $ <br />Total Percent of Change: <br />Increase <br />Decrease <br />% <br />(%) <br /> <br />Time Extension Amount: <br />New Completion Date: <br />