Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />July 19, 2016 <br />Department Div. of Env. Services <br />BPW Date July 26, 2016 Phone Extension (574) 235-9496 <br />Jacob M. Klosinski <br />Legal Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® Carol Kurzhal <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />® Other: Review Liquidated <br />Damaees Discussions <br />Required Information <br />Company or Vendor Name L.D. Docsa Associates, Inc. <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 />Purpose/Description <br />Amount of <br />J Yes N No ❑ If Yes, Approved by Purchasing <br />I MBE ❑ WBE <br />W WTP - Primary Clarifier Upgrades and Equipment Rehabilitation <br />111-071 <br />Divison of Utilities - Wastewater Capital Fund <br />642-0630-415-43-66 <br />Division of Utilities is providing its formal review and recommendations <br />regarding the subject of liquidated damages and special damages for <br />Project. No. 111-071 WWTP Primary Clarifier Upgrades and Equipment <br />Rehabilitation. Division of Utilities seeks the Board direction. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran, etc.) <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />Dispersal After Approval <br />Al Greek <br />Jacob M. Klosinski <br />Carol Kurzhal <br />