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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 04-03-2023 <br />Name: Jacob M. Klosinski Department of Public Works – Engineering Division <br />BPW Date: 04-11-2023 Phone Extension: 9496 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney Attorney Name Michael Schmidt <br />Purchasing Mickey Lovy <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: Ease./Encroach <br />Required Information <br />Company or Vendor Name <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 Water Treatment Chemicals - Wastewater 2023-2024 <br />Project Number TBD <br />Funding Source Sewage Works Operations <br />Account No. 641-06-605-514-422012 (or other accounts) <br />Amount Unit Pricing <br />Terms of Contract One Year Contract – May 1, 2023 through April 30, 2024 <br />Special Contract Provisions <br />Purpose/Description Division of Wastewater requests the Board of Public Works approval to <br />advertise for public quote/bid for unit price quotes for competitive pricing of <br />chemicals and materials for use at the Wastewater Treatment Plant. <br />For Change Orders Only <br />Amount of 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 />Time Extension Amount: <br />New Completion Date: <br />April 11, 2023