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Date <br />Name <br />BOARD OF PUBLIC WORDS <br />AGENDA ITEM REVIEW REQUEST FORM <br />June 30, 2017 <br />Jacob M. Klosinski <br />Department Utilities Wastewater <br />BPW Date July 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 />Purchasing <br />® Carol Kurzhal <br />H Agreement <br />" Contract U Proposal U Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />® Change Order No. 13 <br />❑ <br />CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />FI <br />Other: <br />Company or Vendor Name Thieneman Construction, Inc. <br />New Vendor 0 Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE [WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Wastewater Treatment Plant Secondary Treatment Improvements <br />Project Number 114-053 <br />Funding Source 2017 Wastewater Capital Account <br />Account No. 642-0630-415-43-66 <br />Amount $ <br />Terms of Contract Lump Sum and Unit Prices <br />Purpose/Description The Division of Utilities recommends the approval of Change Order <br />No. 13 which includes additional work as described in the attached <br />Inter -Office Memordandum and Change Order Documents. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of ® increase $ 4,459,00; 0 days to Substantial and Final Completion <br />❑ Decrease $ <br />Previous Amount $ 13,983,645.87 <br />Current Percent of Change: +0.04% <br />New Amount $ 13,988,104.87 <br />Total Percent of Change: +17.70% <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 />