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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: 11-05-2024 <br />Name: Jacob M. Klosinski <br />Department of Public Works — Engineering Division <br />BPW Date: 11-12-2024 <br />Phone Extension: 9496 <br />Required Prior to Submittal to Board <br />BPW Attorney X <br />Attorney Name Michael Schmidt <br />Dept. Attorney ® <br />Attorney Name Michael Schmidt <br />Purchasing ® <br />Mickey Low / Ron O'Connor <br />Check the Appropriate <br />Item Type — Re uired or All Submissions <br />❑ Professional Services Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />® Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />❑ Other: ❑ Ease./Encroach <br />Reauired Information <br />Company or Vendor Name <br />New Vendor ❑ Yes[] If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑ MBE Completed E-Verify Form Attached ❑❑ Nos <br />Project Name 124-058 Locust Water Booster Pump Station Improvements <br />Project Number PROJ- ; PR - <br />Funding Source Water Works — Water Capital <br />Account No. 642-06-605-514-442005 Water Works <br />Amount <br />Terms of Contract <br />Special Contract Provisions <br />Purpose/Description The Division of Engineering and Division of Water requests the Board of <br />Public Works open competitive quotes for the Locust Water Booster Pump <br />Station Improvements at its 11-12-2024 Board Meeting. This project includes <br />the installation of one water booster pump, variable frequency drive, PLC, <br />HMI and ro rammin . <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Increase <br />Decrease <br />Increase % <br />Decrease ( % <br />New Completion Date: <br />