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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/12/2023 <br />Name Becca Plantz Department Public Works <br />BPW Date 05/23/2023 Phone Extension 5998 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name <br />BPW Attorney ❑ Attorney Name Michael Schmidt <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <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 />Information <br />Company or Vendor Name <br />Selge Construction Co., Inc. <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />❑ <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ WBE ❑ Nos <br />Project Name <br />Johnson & Fellows Intersection Drainage Improvements <br />Project Number <br />122-016A <br />Funding Source <br />Stormwater Infrastructure <br />Account No. <br />PR-24005 <br />Amount <br />$242,458.00 <br />Terms of Contract <br />Unit Prices <br />Purpose/Description <br />Drainage improvements at the northeast quadrant of the intersection of <br />Johnson Street and Fellows Street. <br />For Change Orders Onl <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />