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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />July 16, 2018 <br />Tara Weigand <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date July 24, 2018 Phone Extension 5998 <br />PriorRequired to Submittal to Board <br />Legal Z Attorney Name: Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing z <br />Michael Schmidt <br />F1 <br />Agreement Amendment <br />Ll Contract Ll Proposal H Addendum <br />❑ Professional Services <br />0 <br />Resolution <br />❑ <br />Bid Opening <br />F1 <br />Bid Award ❑ Req. to Advertise Title Sheet <br />El <br />Quote Opening <br />Z <br />Quote Award <br />❑ <br />Change Order No. <br />R C/O & PCA No, ❑ PCA <br />❑ Ease/Encroach. <br />F1 Traffic Control: <br />Other: <br />Company or Vendor Name K & R Tree Service <br />0 Yes Z No E] If Yes, Approved by <br />New Vendor Purchasing <br />MBEANBE Contractor <br />MBENVBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />ZME <br />LJ No L] Yes Name of Company <br />2018 Tree and Stump Removal <br />118-04 8A <br />MVH <br />202-0619-431.31-06 <br />$15,625.00 <br />Remove trees and stumps for sidewalk replacement at various <br />locations in South Bend � ,9 , � `7`,-," <br />E] Required Contractor's Certification Form's Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Chan e Orders Only <br />Amount of F] increase $ <br />El Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />Fj Kara Boyles, City Engineer <br />F-1 Marcia Qualls, Streets <br />Tara Weigand, <br />