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Date <br />Name <br />B PW Date <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />February 5, 2018 <br />Jacob M. Klosinski <br />FebnAsfv 13, 2018 <br />Department Utilities Env. Serv. <br />Phone Extension (574) 235-9496 <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 ® *AI Greek, Director of Utilities <br />❑ Agreement <br />L Contract ❑ Proposal LJ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ CIO & PCA No. ® PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />F] Other: <br />Company or Vendor Name Dudeck Roofing and Sheet Metal <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested ❑ No ® Yes Name of Company <br />Project Name WWTP - Compressor Building Roof Replacement <br />Project Number 116-052 <br />Funding Source Utilities - Wastewater - Maintenance Services Building <br />Account No. 641-0630-793-36-01 <br />Amount $ <br />Terms of Contract Lump Sum <br />Purpose/Description Utilities recommends the approval of the Project Completion <br />Affidavit for the subject project. All work is complete. Final Project <br />Cost 251 600.00 +1.13% <br />❑ Required Contractor's Certification Form Attached (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 />El <br />Dispersal After Approval <br />-Al Greek, Director of Utilities <br />Jacob Klosinski, Assistant City Engineer <br />Director of Financial Services, Environmental Services <br />