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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 12-09-2025 <br />Name: Jacob M. Klosinski, PE Department of Public Works – Engineering Division <br />BPW Date: 12-16-2025 Phone Extension: 9496 <br /> <br />Required Prior to Submittal to Board BPW Attorney X Attorney Name Michael Schmidt <br />Dept. Attorney Attorney Name Michael Schmidt <br /> <br />Purchasing Ashley Rzepka / Mickey Lovy <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 Wastewater Treatment Plant Access Road Milling & Paving <br />Project Number PW Project 125-081 / DFO PROJ00000702 <br />Funding Source Sewage Works Operations, Building Repair & Maintenance <br />Account No. 641-06-605-514-436001 <br />Amount <br />Terms of Contract Lump Sum (Four Base Divisions, Contract is Divisible) <br />Special Contract Provisions <br />Purpose/Description This project consists of milling and resurfacing hot mix asphalt access <br />roadway and parking lot pavement at the Wastewater Treatment Plant. The <br />project has four base divisions and selection of award is divisible. MWBE <br />goals are included in the scope of this project. <br />For Change Orders Only <br />Amount of <br /> <br />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 /> <br />Time Extension Amount: <br />New Completion Date: <br />