City of Nashua Central Purchasing Department
ADMINISTRATIVE SERVICES DIVISION
Request to Include on Finance Committee Agenda _] Request to Solicit Bid or Proposal
Date of Request: August 24, 2020
Proposed Finance Meeting Date: September 2, 2020
Project or Item Title: Design Build Fuel Island Project - Change Order #1
Amount: $22,299
Lawson RQ#
Or Lawson
POF if
Change 156362
Order
Funding Description: Fuel Depot Rehabilitation.
Accounting (Finance Committee): _ 61.1001 81100 2075.61.19.30 54210
Acctg Unit Acct Sub Acct Activity Acct Category
Requesting Department:
(J Information Technology [| Police Department
[_] Engineering . (] Fire Rescue
Streets [_] Community Development
C] Traffic ] Public Health
_] Park Recreation C Financial Services
[_] Wastewater ("] Administrative Services
[] Solid Waste [) Other
(J Library
Has Legal reviewed this request? If no, please explain in Other comments: Yes [J No
Has Risk reviewed this item? If no, please explain in Other comments: Yes L] No
Are CDBG Funds being used for this item? [] Yes L] No
Is this a time sensitive project? [] Yes [] No
For Solicit Bid — is a list of bidders attached? (] Yes [] No
Has this item been budgeted in the CERF fund? L1 Yes L] No
Other comments: Standard City Change Order Template will be executed
Attach supporting documents (bid document, bid tabulation, contract, etc.)
Approval XS.
Requester: . Division Director: A
CFO (or designee): Date:
Director — Admin Services: Date:
Note: This form will be returned unless fully completed.
