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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 11, 2018 <br />Name Jacob M. Klosinski Department Utilities Wastewater <br />BPW Date December 20, 2018 Phone Extension 574 235-9496 <br />a NAB I16MMIIIIIIIIIIIIIIIIIImImImWMWYC'OFF i6P6PkR?WUSir1bd'W�iAA3i,'J' nrr&F1 vE A.WMIMIYIW!IYJ MN 4fP�YSN'f% 'r' .... <br />_ Rewired Prior to Submittal to Board _ <br />Legal W ® Attorney Name Clara MdDaniels, Assistant City Attorney <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Z Al Greek„ Director of Utilities <br />........ ......�........�... ............�....................... ....m .ww .. . <br />Check the mAroariate Item Tremmm Required for All_Submissions <br />Agreement F Contract E] Proposal ❑I Addendum <br />[ Professional Services E, Resolution <br />❑' Bid Opening F-1 Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening Z Quote Award <br />❑ Change Order No. J C/O & PCA No. ❑ PCA <br />Ease/Encroach. 0 Traffic Control <br />Other: <br />Rewired Information <br />Company or Vendor Name <br />New Vendor <br />F-1 Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />__PManic Resources Facility - Brea room Addition <br />Project Number <br />not assicned <br />Funding Source <br />2018 Sewage Works Operations, Contractual Services Othermmmmmm.m <br />Account No. <br />641-0631-793-63-35 <br />Amount <br />$ 41,180.00 <br />Terms of Contract <br />Lump Sum <br />Purpose/Description <br />_ <br />The Division of Utilities recommeds the Board of Public Works <br />award the quotation for the subject project to the most responsive, <br />responsible bidder, MI&V Pro Services <br />❑ Required Contractor's Certification Form Attached (Non- <br />..._ __....�� <br />Collusion, Non -Discrimination„ Non -Debarment, E-Vermifyr Iran„ etc.;) <br />Reauired For Change Orders Oniv <br />