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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 16 2019 <br />Department <br />Name Jacob M. Klosinski En ineerin / Utilities <br />BPW Date Se tenter 2 20'l.9 Phone Extension Ext. 9496 <br />�� �w,wiwwnai uvuzervr�n imirvvmmmm��i rr�m� <br />... ............._.._.._... e uired Prior to Submittal to Boar. ........ . ........................... <br />R <br />._ .9 _. d _..� . ._. �....__ <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br />Purchasing F <br />Check the A <br />Profession. __.__....-................. <br />al Services Agreement <br />❑ Open Market Contract <br />E] Bid Opening <br />El Quote Opening <br />Fj Proposal Opening <br />I j Chg. Order, No. <br />❑ Other: <br />Item Type —Required.f6r All Submissions <br />" Contract <br />❑ Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />® C/O & PCA No. 1 <br />❑ Traffic Control <br />Reau red Information <br />Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />E] Reject Bids/Quotes <br />PCA <br />E] Resolution <br />Ease./Encroach <br />❑ Title Shee <br />or John Boettcher Sewer & :1:xc�aa�at�n�, Inc. Vendor Name J .. .._. <br />Company <br />�] Yes1] If Yes, Approved by Purchasing <br />New Vendor ] No <br />MBE/WBE Contractor MBE Completed E-Verify Form Attached ❑ Yes <br />F] WBE No <br />Project Name Farmm on..14A Lift Station Rehabilitation....S......................................�.��.._w _� � .....�...... .............�.w—.. <br />Project Number 117-027 <br />Funding Source Utilities, Wastewater Ca ital <br />Account No. 642-0630-415-43-66 <br />..................... <br />_......_�_�.....�__� ��............__......�w.. <br />Amount <br />Terms of Contract <br />Purpose/Description The Division of En gincering and Division of Utilities request the Board o <br />Public Works approval of Change Order No. 1 Final,_adustment of final <br />quantities),, Pr9jeq "om', letion Affidavit,and Maintenance Bond for the <br />subject proiect. All work is con late. <br />For CLn, e Orders l w_u <br />Amount of Increase $ <br />Decrease � _ �.. ... .... .... ..... ___ �... <br />® ($ 23 125.23) <br />Previous Amount $ 360.577.79 <br />Increase <br />% .�.��.0 <br />Current Percent of Change: <br />g <br />Decrease <br />6.�.�.�.�.�.�.�.�.�.�.� .�. <br />(.41 %) <br />New Amount <br />$ 337,452.56 <br />._... �.� ................................................... <br />Increase <br />Total Percent of Change: <br />Decrease <br />(6.41 %) <br />Time Extension Amount: <br />140 Dais, Adjust due to Electrical Cabinet Supplier Delay <br />New Completion Date: <br />09/30/2018 <br />