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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 5, 2018 <br />Name Jacob M. Klosinski Department Div. of Env. Services <br />BPW Date February 13, 2018 Phone Extension (574) 235-9496 <br />Reg uired Priorto Submittal toBoard <br />Legal ® Attorney Name Clara McDaniels <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 ® *Al Greer, Director of Utilities* <br />Check the A propriate Item Type -Required for All Submissioijs <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. 001 ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />n Other: <br />Company or Vendor Name Thieneman Construction, Inc. <br />New Vendor ❑ Yes ® No El If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />Project Name Wastewater Treatment Plant - Digester Gas Utilization Project <br />Project Number 116-05OR <br />Funding Source Wastewater Capital Improvements and Other Contractual Services <br />Account No. 642-0630-415-43-66 (Capital) and 642-0630-793-63-35 (Oth Contr Serv) <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Previous Amount <br />Lump Sum (Not to Exceed, subject to final quantities for unit price items) <br />The Division of Utilities recommends a approval of Change Order No. 1 <br />for deletions and adjustments to the scope of work for the project project. <br />Refer to Inter -Office Memorandum for description of changes. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment, E-Verifv. Iran, etc.) <br />❑ Increase $ <br />® Decrease $ 30,827.00 <br />$ 754,000.00 <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />-4.09% <br />$ 723,173.00 <br />-4.09% <br />Dispersal After Approval <br />Al Greek, Director of Utilities <br />Jacob M. Klosinski, Assistant City Engineer - Wastewater <br />Director of Financial Services, Environmental Services <br />