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BOAR OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 12, 2018 <br />Name Jacob M. Klosinski Department Utilities - Wastewater <br />Purchasing <br />® Al Greek, Director of Utilities <br />U <br />Agreement <br />U Contract <br />L] Proposal H Addendum <br />❑ <br />Professional Services <br />❑ <br />Amendment <br />❑ Bid Opening <br />❑ <br />Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />® Chg Order No. 2 <br />❑ CIO & PCA No. <br />❑ PCA <br />E] Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />F] <br />Other: <br />n Claim <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE Contractor <br />Project Name <br />Project Number <br />Thieneman Construction, Inc. <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑❑ WBE Completed E-Verify Form Attached ❑Nos <br />Wastewater Treatment Plant Diaester Gas Utilization <br />116-050 <br />Wastewater Capital Improvements and Other Contractual <br />Funding Source Services <br />Account No. 642-0630-415-43-66 (Capital) & 642-0630-793-63-35 (O.C.Serv. <br />Amount **Change Order, Se_ _e Below`* <br />Terms of Contract Lump Sum <br />Purpose/Description Change Order No. 2 addresses a deduction to the contract price <br />of $30,000 associated with liquidated damages for not meeting <br />the contractual reauirements for Substantial Com►)letion.. <br />Amount of <br />Previous Amount <br />❑ Increase $ <br />® Decrease $ 30,000.00 <br />$ 723.173.00 <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change. - <br />Time Extension: <br />Copy <br />Original <br />® <br />❑ <br />-3.98% <br />$ 693,173.00 <br />-8.07% <br />nla <br />Dispersal After Approval <br />Eric Horvath, Director of Public Works <br />Kara Boyles, City Engineer <br />Al Greek, Director of Utilities <br />