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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 28 2019 <br />Name Jacob M. Klosinski Department Utilities <br />BPW Date March 12 2011 Phone Extension Ext. 9496 <br />_... _ Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney <br />Attorney Name Clara McDaniels <br />Purchasing ® <br />Michael. Schmidt, Purchasin • Al Greeli Director of Utilities <br />Check the A iITopriate Item C�ype - ? yi , r• All Submissions <br />[� <br />Professional Services Agreement ❑ Contract <br />❑ Proposal <br />Open Market Contract <br />0 <br />Amendment/Addendum <br />Ej Special Purchase, QPA <br />Bid Opening <br />] <br />Bid Award <br />[:] <br />Req. to Advertise ❑ Title Sheet <br />F] <br />Quote Opening <br />Z <br />Quote Award E] <br />Reject Bids/Quotes <br />F] <br />Proposal Opening <br />❑ C/O & PCA No. F-1 <br />PCA <br />] Chg. Order, No. <br />❑ Traffic Control ❑ Resolution <br />Other:11atify Qu,ote Award <br />0 Ease./Encroach <br />......_...............-...... �_ ._....... ..... <br />Required Information <br />Company or Vendor Name <br />Zimmerman Industrial Pi inn, Incur....- <br />mYes <br />] If Yes, Approved by Purchasing <br />New Vendor <br />Z <br />No <br />MBE/WBE Contractor <br />MBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />WWTP Reuse Building Wall Repairs <br />........._................._._._.................... <br />Project Number <br />............. <br />n/a <br />Funding Source <br />.... _.,.. _ .._. <br />Utilities, Wastewater, Equipment Repair & Maintenance Account <br />_...................www w <br />Account No. <br />641-0630-793-36-05 <br />Amount <br />§................. -w <br />15,652.00 <br />Terms of Contract <br />Lump Sum, Unit Prices - Not to Exceed <br />Purpose/Description The Division of Uti I:ities requests the Board of Public Works ratify the Quot, <br />Award for the subject work. The work was com leted in 2018 and approves <br />by Public Works and <br />For Change Orders pi l <br />.........._ .. -.. <br />Amount of ❑ Increase $ —.- _.---- <br />............. _...._. ...... <br />❑I Decrease ($ ) <br />Previous Amount <br />$ <br />Increasemmmm <br />% <br />Current Percent of Change: <br />Decrease <br />mmT% <br />New Amount <br />$ <br />_....._.... w <br />Increase <br />%Y <br />Total Percent of Change: <br />Decrease <br />% <br />Time Extension Amount: <br />New Completion Date: <br />