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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 07-17-2023 <br />Name: Jacob M. Klosinski Department of Public Works – Engineering Division <br />BPW Date: 07-25-2023 Phone Extension:9496 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney Attorney Name Michael Schmidt <br />Purchasing Mickey Lovy / Ron O'Connor <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 South Well Field – Water Main Extension <br />Project Number 117-059B / PROJ# 00000082 / PR-00026362 <br />Funding Source Southside Development #1 <br />Account No. 430-10-102-121-444000 <br />Amount <br />Terms of Contract Lump Sum (Unit Prices) <br />Special Contract Provisions <br />Purpose/Description The Division of Engineering and Division of Water Works request the Board <br />of Public Works approval of a Title Sheet and Request to Advertise for the <br />South Well Field Water Main Extension. This project will extend water <br />transmission main from Chippewa Avenue to Ireland Road. <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: July 25, 2023