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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 29, 2018 <br />Name Charlotte Brach <br />- <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date December 11, 2018 Phone Extension 9246 <br />Imo""' oommmm ww mmummua u�awu'rm <br />ITmIT�_ _m___.. a uired Prior to Submittal to Board <br />Legal ❑ 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 ❑ Michael Schmidt <br />.�.._ _ Check the A ct...s Typeetrred for All Submissions <br />F1 Agreement AmendmentContra��- <br />El ❑ Addendum <br />F] Professional Services ❑ Resolution <br />[� Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ® Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />n Ease/Encroach. n Traffic Control: <br />Other: <br />Required Information <br />Company or Vendor Name Acorn Landso p�q LLC <br />l Yes El No If Yes, Approved by <br />New Vendor <br />Purchasin� _.......�_. ................... <br />MBE/WBE Contractor <br />.� � ........ <br />❑ MBE M WBE <br />MBE/WBE Contractor Requested <br />q <br />m..._ .. <br />� _No � Yes.. Name of Corwp <br />Project Name <br />... Replacement <br />Mishawaka Avenue TreeR mmmm_ .......... <br />Project Number <br />118-111 <br />Funding Source <br />Complete Streets Transportation <br />....._. .. _�. ... <br />Account No. <br />404-1001-460-42.30 <br />Amount <br />$21,839.50 <br />Terms of Contract <br />Lump Sum - mITmmm <br />� . _ .._..... <br />Purpose/Description <br />.................dss <br />Replace trees and grates in front of Bamber Market, <br />E Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />_..._ uIred For Ch ng_ mOrders Only <br />�] Increase $ <br />Amount of _.......�� ..... ..........�_ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: ............. <br />...._._....%��... ............. �.......... ..............................-�. <br />..._..���..._��..����........mwm_.__ ,.. <br />New Amount $ ............. <br />Total Percent of Char: % <br />Disoersal After Aooroval I <br />Copy <br />Original <br />® <br />❑ Kara Boyles <br />® <br />E Toy Villa <br />0 <br />EJ <br />