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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 7/31/2023 <br />Name: Charlie Brach Department of Public Works — Engineering Division <br />BPW Date: 8/22/2023 Phone Extension: 9246 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />❑� <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. 1 ❑ Traffic Control ❑ Resolution <br />I-1 Other: I —I Ease./Encroach <br />Information <br />Company or Vendor Name Selge Construction Co. <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 />LJ Yes LJ If Yes, Approved by Purchasing <br />❑ No <br />F] MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />122-014C 2023 Traffic Calming <br />PROJ316 <br />251-442001 <br />PO # 23430 (Division 1), PO # 23429 (Division 2), PO # 23419 (Division <br />3), PO # 23411 (Division 4), PO # 23428 (Division 5), PO # 23427 <br />(Division 6) <br />$59,656.85 <br />Divisions <br />N/A <br />Change Order for the 2023 Traffic Calming Project to add curb, #53 <br />Aggregate and Thermoplastic Striping. <br />For Change Orders Onl <br />Amount of ® Increase $ 59,656.85 <br />❑ Decrease ($ ) <br />Previous Amount $ 1,750,570.00 <br />Increase <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ 1,810,226.85 <br />Increase <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />