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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 05-06-2025 <br />Name: Jacob M. Klosinski Department of Public Works — Engineering Division <br />BPW Date: 05-13-2025 Phone Extension: <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 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 />® Other: Ratify Emergency ❑ 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 />Amount of <br />Previous Amount <br />Information <br />Construction C <br />Inc. <br />U YesU If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached El Yes <br />❑ No <br />Emergency Sewer Repair at Western and Chapin Intersection <br />N/A <br />641-06-602-509-439001 Sewage Works Operations, Other Contract. Svcs. <br />PO #0037116 <br />$220,379.51 <br />Time and Materials — Emergency Work <br />The Division of Engineering and Division of Streets & Sewers requests the <br />Board of Public Works ratify the Emergency Repair Work purchase order for <br />a sewer collapse repair at the intersection of Western and Chapin. A sewer <br />collapse was identified and required structure and pipe replacement due to a <br />fiber optic conduit bore that had been bored through the sewer. <br />❑ Increase <br />❑ Decrease <br />Current Percent of Change <br />New Amount <br />For Change Orders <br />Increase % <br />Decrease ( % <br />Increase % <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />New Completion Date: <br />