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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date -August 29, 2019 <br />Name Alicia Czarnecki Department Engincerip <br />BPW Date September Ifile, 2019 Phone Extension 5903 <br />i�9� wmaaawaea wear w�mmmmmmmmmmmmuuuuuuuuuuuuuuuuuuuuuuummuuuuuumm mmmwnmimnmrrrrawmn <br />Required Prior to Submittal to Board <br />BPW Attorney FJ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing El <br />Check the Appropriate Item Type — Rep <br />[l Professional Services Agreement Contract <br />[_� Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />0 Quote Opening ® Quote Award <br />[� Proposal Opening ❑ C/O & PCA No. <br />[� Chg. Order, No. ❑ Traffic Control <br />[� Other: <br />Information <br />� Company or Vendor Name Douglas Landscape, Inc. <br />All Submissions <br />...._.._ ......... <br />L_J Proposal <br />[l Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />❑] Resolution <br />Ease./Encroach <br />U Yes U If Yes, Approved by Purchasing <br />New Vendor ❑ No <br />MBE/WBE Contractor ❑MBE Completed E-Verify Form Attached <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />❑ WBE <br />2019 Tree Planting_ <br />119-013 <br />MVH <br />202-0619-431.31-06 <br />$12,320.00 <br />❑ Title Sheet <br />❑ Yes <br />❑ No <br />Planting of trees within the right of way_at various locations in South Bend. <br />_... _.....-.__ .. ............._ .mmmm ...:.. <br />For Change Orders Only� <br />Increase $ <br />Amountof $ �. .�.�....._ ._......� ........... ....... <br />ElDecrease ..�....................mwmw_ .............. _�W_ .�._..-..............................................._..............._ <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />% <br />Decrease <br />( % o <br />Increase..._.._.....................�.�.�._...............................% <br />..... - <br />Decrease <br />( % <br />