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I30ARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 20, 2016 <br />Name Jacob M. Klosinski Department Div. of Env. Services <br />BPW Date December 22, 2016 Phone Extension (574) 235-9496 <br />Required Prior to Submittal to Board <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 />❑ Agreement LJ Contract LJ Proposal LJ 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: Amendment 2 to PSA <br />Required Information <br />Company or Vendor Name Greeley and Hansen, LLC <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 X No ❑ If Yes, Approved by Purchasing <br />I MBE ❑ WBE <br />W WTP - Digester Gas Utilization <br />116-050 <br />Utilities, Wastewater Capital <br />641-0630-793-36-05 <br />The Division of Utilities requests the Board of Public Works approval of <br />Amendment No. 2 for the subject project for adjustments in the scope of <br />work for re -bidding the subject project and reduction in Construction <br />Administration Services. Adjusted scope results in no cost increase. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />.... ............ <br />Copy Original <br />® ❑ Al Greek <br />® ❑ Jacob M. Klosinski <br />® ❑ Carol Kurzhal <br />