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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />March 31, 2017 <br />Jacob M. Klosinski <br />Department Utilities - Wastewater <br />BPW Date Aril 11, 2017 Phone Extension 574 235-9496 <br />Re uired `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 />Company or Vendor Name Thieneman Construction, Inc. <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Wastewater Treatment Plant Grit and Screenings Improvements <br />Project Number 114-075 R <br />Funding Source Utilities, Wastewater, Treatment and Disposal Equipment Account <br />Account No. 642-0630-415-43-66 <br />Amount $ <br />Terms of Contract Lump Sum <br />Purpose/Description The Project Completion Affidavit, Maintenance Bond and Certificate <br />of Substantial Completion are submitted to the Board of Public <br />Works for approval. The Contractor has completed all work for the <br />subject project. <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of ❑ Increase $ <br />❑ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: 0/0 <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ❑ Al Greek, Director of Utilities <br />® ❑ Jacob M. Klosinski, Assistant City Engineer <br />® ❑ Carol Kurzhal, Director of Financial Services, Environmental Services <br />