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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />January 24, 2018 <br />Jacob M. Klosinski <br />Purchasing <br />Department Div. of Utilities (ORF <br />® *Al Greek, Director of Utilities* <br />L_ Check the Appropriate Item `Type Required for All Submissions _ <br />U 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. ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />F] Other: <br />Company or Vendor Name <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 2018 Trucking of Belt Pressed Biosolids for Land Application <br />Project Number <br />Funding Source Utilities, Organic Resources, Contractual Services Other <br />Account No. 641-0631-793-63-35 <br />Amount $ <br />Terms of Contract <br />Purpose/Description Request to advertise for the project for bid pricing at a "per truck 1 <br />per hour" price for the transportation of belt pressed biosolids for <br />land application (refer to memorandum for details). Advertise <br />02/16/2018 & 02/23/2018. Bid Open & Award 03/13/2018. <br />❑ Required Contractors Certification Form Attached tached (Non - <br />Collusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />Dispersal After Approval <br />Al Greek, Director of Utilities <br />Jacob M. Klosinski, Assistant City Engineer <br />Director of Financial Services. Environmental Services <br />