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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/04/2018 <br />Name Toy Villa _,,,<1 Department Engineering <br />BPS/ Date 09/11/2018 Phone Extension 5920 <br />. .... ..... . .. .... . .... <br />Legal F1 Attorney Name <br />Controller El 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 ❑ Michael Schmidt <br />H Agreement <br />LJ Contract H Proposal LJ Addendum <br />F1 Professional Services <br />F-1 Resolution <br />F-1 Bid Opening <br />F-1 Bid Award F-1 Req. to Advertise ❑ Title Sheet <br />F1 Quote Opening <br />F-1 Quote Award <br />Z Change Order No. I <br />El C/O & PCA No. ❑ PICA <br />F-1 Ease/Encroach. <br />El Traffic Control <br />F- Other: <br />Company or Vendor Name Selge Construction Co., Inc. <br />New Vendor El Yes F-1 No El If Yes, Approved by Purchasing <br />MBEANBE Contractor [:] MBE [J WBE <br />MBENVBE Contractor Requested [:] No [:] Yes Name of Company <br />Mishawaka Avenue — Roto Rooter Jetter Removal and-No-rth-Sbofe <br />Project Name _Dr4ve-lrn,p°roveffients <br />Project Number 118-069R <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Sewer Capital <br />641.0621.792.63.35 <br />Additional modifications with replacing catch basins and inlets on <br />North Shore Drive <br />n Required Contractor's Certification Form Attached (Non - <br />Collusion. Non-DIis,cri:m i nation, Non -Debarment. E-Verlfv. Iran, etc. <br />Increase $19,507.00 <br />Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />F-1 <br />F-1 <br />1:1, <br />11 <br />$ 52,800.100 <br />36,95% <br />72,307.00 1 -- <br />36.95% <br />M - of 0 . <br />