Change Order No 3 - North Station Well #1 Replacement Proj No 117-031R - Peerless Midwest

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 9/03/19 ... ... ........................ � Department Public Name Becca Plantz Works BPW Date 9/10/19 Phone Extension 5998 Required Prior to Submittal to Board ....................................... BPW Attorney Attorney Name Dept. Attorney n Purchasing ❑ Check the At Attorney Name Item T v - Required for All Submissions LJ Professional Services Agreement H Contract F-] Open Market Contract ❑ Amendment/Addendum E] Bid Opening ❑ Bid Award ❑ Quote Opening ❑ Quote Award ❑ Proposal Opening F-1 C/O & PCA No. Chg. Order, No. 3 El Traffic Control Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Information �] Proposal ❑ Special Purchase, QPA Req. to Advertise ❑ Title Sheet Q Reject Bids/Quotes PCA Resolution Ease./Encroach Peerless Midwest . _ [] Yes] If Yes, Approved by Purchasing No ❑ MBE Completed E-Verify Form Attached Yes ❑ WBE ] No North Station Well No.m 1 Replacement 117-031R Water Works 62206406614602 Lump Sum ........ .........—...._ ............ Provide and install V 1 K open enclosure and output filter. For Change Orders Only Amount of Increase $ 3,988 00 ... .................... ........- ❑ Decrease$....._......) Previous Amount $ 543,570.72 ........... Increase ....................................... 0.73% .............. Current Percent of Change: Decrease _...a (0% New Amount $ 547,558.72 Increase ..... -.............. 2.78% Total Percent of Change: Decrease (0%) Time Extension Amount: 0 ._........_m..-__.__ ........ New Completion Date: 12/21 /2019