Change Order No 2 - LWW and Charles Martin Sr Dr Intersection Improvements Project No 117-072A - Selge Construction Co Inc

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11 /19/2018 Name Kyle Silveus Department Engineering_ m w BPW Date 11 /27/2018 Phone Extension 9083 H Required Prior to Submittal to Board Legal Attorney Name Clara McDaniels Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc greater than one year in length per the City Purchasing Policy Purchasing ❑ Michael Schmidt Check the A r9priate Iteor All Submissions Agreement ❑ Contract El Proposal ❑ Addendum ❑ Professional Services ❑ Resolution ❑ Bid Opening 0 Bid Award Req. to Advertise ❑ Title Sheet n Quote Opening E] Quote Award Z Change Order No. 2 El C/O & PCA No. ❑ PCA Ease/Encroach. E] Traffic Control [� Other: Required Information Company or Vendor Name Sei e Construction Co. Inc. New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name LWW Charles Martin Intersection Improvements Project Number 117-072A Funding Source RWDA Account No. .... .............. ...... __..-.._.......................... 324-1050-460-42.03 Amount _pW �... ...... ...- $ 25,800.09 Terms of Contract ........................... _.. Purpose/Description Intersection Improvements at Lincolnway WestandCharles Martin ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Required For Change Orders , Only Amount of N Increase $ 25, 9 Decrease $ Previous Amount $ 1,160,109.44 Current Percent of Change: 2.22% New Amount $ 1,185,909.53 Total Percent of Change: 4.85% Dispersal After Approval Copy Original ❑I n El