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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 8, 2018 <br />Name Tara Weigand <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date June 12, 2018 Phone Extension 5998 <br />'Required Prior to Submittal to Board <br />Legal Attorney Name: Clara McDaniels <br />Controller El Controller review is required for all Contracts $5,0100.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Michael Schmidt <br />L] Agreement Amendment <br />F-1 Professional Services <br />F Bid Opening <br />F-1 Quote Opening <br />[] Change Order No. <br />F-1 Ease/Encroach. <br />F Other: <br />■ <br />Contract <br />Resolution <br />❑Bid Award <br />041 Quote Award <br />19 C/O & PCA No. <br />21 Traff ic Control: <br />R Req. to Advertise E:1 Title Sheet <br />XM <br />Company or Vendor Name Kachur Tree Service, LLC - <br />N� Yes F1 No [:]-If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEANBE Contractor <br />MBE F-1 WBE <br />MBE/WBE Contractor <br />Requested F1 No E] Yes Name of Company <br />Project Name <br />2018 Tree and Stump Removal <br />Project Number <br />11 8-,048A <br />Funding Source <br />MVH <br />Account No. <br />202-0619-43,1.31-06 <br />Amount <br />$12,675.00 <br />Terms of Contract <br />Purpose/Description <br />Remove trees and stumps for sidewalk replacement at various <br />locations in South Bend <br />Required Contractor's Certification Forms Attached (Nan <br />Collusion, Non -Discrimination, (Non -Debarment, E-Verify, Iran, etc,) <br />Required For Change Orders Only <br />. . . . ..... _ .­­ --- ] <br />Amount of ❑ <br />❑ <br />increase $ <br />Decrease <br />Previous Amount <br />$ <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />Kara Boyles, City Engineer <br />Marcia Qualls, Streets <br />❑ <br />Tara Weigand <br />