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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 02-20-2024 <br />Name: Jacob M. Klosinski Department of Public Works — Engineering Division <br />BPW Date: 02-27-2024 Phone Extension: 9496 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney ® Attorney Name <br />Michael Schmidt <br />Purchasing ® Mickey Low / 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 />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 />❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />WWTP Degrit Building Yard Piping Replacement <br />123-031A / PROJ00000435 <br />Sewage Works - Wastewater Capital <br />PR/PO # <br />The Division of Engineering and Division of Wastewater requests the Board <br />of Public Works receive and open bids for the subject project on 02/27/2024 <br />at its Regular Board Meeting. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase % <br />Decrease ( %) <br />Increase % <br />Decrease ( %) <br />