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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 12, 2017 <br />Name Jacob M. Klosinski <br />Department Utilities Wastewater <br />BPW Date May 23, 2017 Phone Extension (574) 235-9496 <br />❑ Agreement ❑ Contract ❑ Proposal U Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />® Change Order No. 1 ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I —I Other: <br />Company or Vendor Name HRP Construction, Inc. <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE Contractor <br />Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Calvert Street Lift Station Replacement <br />Project Number <br />116-053 <br />Funding Source <br />Wastewater Capital Account <br />Account No. <br />642-0630-415-43-66 <br />Amount <br />$ <br />Terms of Contract <br />Lump Sum and Unit Prices <br />Purpose/Description <br />The Division of Utilities recommends the Board of Public Works <br />approval of Change Order No. 1 which includes changes to the <br />scope of work see Inter -Office Memorandum for Details). <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Chan' e Orders Only <br />Amount of ® <br />Increase $ 10,805.80 + 0 Days to Substantial & Final Completion <br />❑ <br />Decrease $ <br />Previous Amount <br />$ 917,000.00 <br />Current Percent of Change: +1.18%% <br />New Amount <br />$ 927,805.80 <br />Total Percent of Change: +1.18% <br />Dispersal After Approval <br />Copy Original <br />® ❑ <br />Al Greek, Director of Utilities <br />® ❑ <br />Jacob M. Klosinski, Assistant City Engineer <br />® ❑ <br />Carol Kurzhal, Director of Financial Services, Environmental Services <br />