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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 04-17-2023 <br />Name: Jacob M. Klosinski Department of Public Works — Engineering Division <br />BPW Date: 04-25-2023 Phone Extension: 9496 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney ® Attorney Name <br />Purchasing ® Mickey Low <br />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 />n Other: n Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Special Contract Provisions <br />Purpose/Description <br />Information <br />U YesU If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Water Treatment Chemicals - Wastewater 2023-2024 <br />Sewage Works Operations <br />641-06-605-514-422012 (or other accounts) <br />Unit Pricing <br />One Year Contract — May 1, 2023 through April 30, 2024 <br />Division of Wastewater requests the Board of Public Works publicly open <br />bids for Wastewater Treatment Chemicals at its meeting on April 25, 2023. <br />Bids will be unit price bids. Bids will be reviewed by Wastewater and <br />Engineering rior to recommendation for award in May 2023. <br />For Change Orders Onlv <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Increase <br />Decrease <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />