Project Completion Affidavit - Four Winds Field Landscaping - Foegley Landscape Inc

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Name 04/18/2019 Patrick Sherman Department VPA BPW Date 04/23/2019 Phone Extension 5601 ➢flfl � 18N' ' 91IIWwwvwml � NNMdN 'N�W@WWMI@IIIIIIII w�ww�IwVIVIVIVIV _._ ._.W....._ ..... _ Required Prior to Submittal to Board q Legal ® Attorney Name Clara McDaniels Controller z Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing Z Michael Schmidt Check the Agreement Professional Services Bid Opening �] Quote Opening Change Order No. El Ease/Encroach. F-1 Other: Egpnate Item Type — Reli El Contract ❑ Resolution Bid Award El Quote Award El C/O & PCA No. F Traffic Control or All Submissions .. Proposal ❑ Req. to Advertise Reluired Information Company or Vendor Name Foegley Landscaping Inc. Addendum ❑ Title Sheet New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name Four Winds Field L.... ...... ............... andsca�ing �._....................................................... Project Number 1075-2018 Funding Funding Source �ww ............................. _........ .... Non -reverting Cove fund Account No. 401-1101-452.36.09 Amount $ 32,955.00 Terms of Contract Complete by April St, 2019 __.. Purpose/Description Project Completion Affidavit Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Required For Cane Orders Only Amount of Increase $ - Decrease $ Previous Amount $ 32,955 Current Percent of Change: 0% New Amount $ 32,955 Total Percent of Change: 0% Dispersal After Approval Copy Original ❑ ❑ ❑ El El El