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Home My WebLink AboutQPA Purchase - GameTime Sinclair Recreation - Playground Equip for 2019 Parks Upgrade Program1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOT ITH BEND. 1NDIANA 46601-1 930 1865 CITY OF BEND PETE BUTTIGIEG, MAY BOARD OF PUBLIC December 11, 2018 GameTime c/o Sinclair Recreation PO Box 1409 Holland, MI 49422 RE: QPA Purchase Dear Vendor: PHONE 574/235-9251 FAx 574/ 235-9171 The Board of Public Works, at its meeting held on December 11, 2018, approved the above referenced purchase of playground equipment as part of the 2019 Parks Upgrade Program in the amount of $214,802.60. Enclosed please find a copy of the agreement for your records. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, Linda M. Martin, Clerk Enclosure GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU AGREEMENT FOR GOODS AND SERVICES This Agreement for goods and services (this "Agreement") is entered into on December 1 lth, 2018 (the "Effective Date"), by and between the City of South Bend, acting by and through its Board of Public Works (the "City"), and Sinclair Recreation, LLC a Michigan corporation, with its Principal place of business located at 128 E. Lakewood Blvd, STE 40, Holland, MI (the "Provider") (each a "Party" and collectively the "Parties"), For and in consideration of the mutual covenants and promises contained herein, the Parties agree as follows: 1. Goods and Services. The Provider will provide to the City the goods and services ("Goods and Services") set forth in the Provider's proposal attached hereto as Exhibit A (the "Proposal"), which Proposal is incorporated herein. In the event of any conflict between the terms of this Agreement and the terms of the Proposal, the terms of this Agreement will prevail. 2. f`onipensation. In exchange for the Goods and Services, and subject to the terms and conditions of this Agreement, the City will pay the Provider the fee stated in the Proposal (the "Contract Amount") in accordance with the project budget stated in the Proposal. The City will pay the Contract Amount in installments upon invoicing by the Provider as set forth in the Proposal (each a "Contract Installment"). The City will not be required to pay any Contract Installment if any material default or breach of this Agreement by the Provider exists. The sum of all Contract Installments will not exceed the Contract Amount, and the Provider will not incur or seek reimbursement for any expenses in excess of the Contract Amount. 3. 're n ; Terininationt, Unless earlier terminated in accordance with its terms, this Agreement will commence on the Effective Date and end upon the Provider's satisfaction of all its obligations hereunder and the City's final payment therefor. Notwithstanding the foregoing, effective immediately upon delivery of a written termination notice to the Provider, the City may terminate this Agreement, in whole or in part, for any reason, if the City determines that such termination is in the best interest of the City. In addition, in accordance with Ind. Code 6-1.1-18- 4, payments are subject to annual appropriation by the City. If the City makes a written determination that funds are not appropriated or are otherwise unavailable to support the continuation of this Agreement, it shall be cancelled. A determination by the City that funds are not appropriated or are otherwise unavailable to support the continuation of performance shall be final and conclusive. The City will not be required to pay any Contract Installment or be otherwise liable for any cost associated with the Provider's performance of any Services after the effective date of termination. 4. Remedies for Breach of Contract. Failure to provide the Goods and Services in accordance with this Agreement will be considered a material breach. In the event of such breach, the City may suspend all payments to the Provider and may pursue any and all remedies available at law or in equity. The Provider shall repay to the City any portion of the Contract Amount expended for matters not within the scope of the Services. Point of Contact. The City employee identified in Section 9 below will serve as the City's principal point of contact for purposes of this Agreement. 6. tclatronsitip. The Provider shall at all times be an independent contractor for all services performed and goods supplied rather than an employee of the City, and no act or omission to act by the Provider shall in any way bind or obligate the City. This Agreement is strictly for the benefit of the Parties and not for any third party or person. This Agreement was negotiated by the Parties at arm's length and each of the parties hereto has reviewed the Agreement after the opportunity to consult with independent legal counsel. Neither party shall maintain that the language in the Agreement shall be construed against any signatory hereto. The City and the Provider hereby renounce the existence of any form of agency relationship, joint venture, or partnership between the Provider and the City and agree that nothing contained herein or in any document executed in connection herewith shall be construed as creating any such relationship between the City and the Provider. 7. Indemnification of City. The Provider hereby agrees to defend, indemnify, and hold harmless the City, its officials, employees, and agents from any and all claims of any nature which arise from the performance by the Provider under this Agreement and from all costs and attorney fees in connection therewith, excepting for claims arising out of the negligence of the City, its officials, directors, employees, and agents. The obligations of the Provider under this section shall survive the termination of this Agreement. 8. An . L�mcgt. The Provider shall not assign or subcontract the whole or any part of this Agreement or its obligations hereunder without the prior written consent of the City. 9. Notices. Any notice required or permitted to be delivered hereunder shall be deemed to be delivered, whether or not actually received, when deposited in the United States Postal Service, postage prepaid, registered or certified mail, return receipt requested, addressed to the City or the Provider, as the case may be, at the address set forth below. Provider: Sinclair Recreation, LLC 128 E. Lakewood Blvd, Ste 40 Holland, MI 49424 Attn: Rocki Stillson City City of South Bend Venues Parks & Arts Department 1020 High Street South Bend, IN 46601 Attn: Nick Gaul 10. Equal Opportunity; Non -Discrimination: ConlDliance. The Provider shall comply with all applicable laws and regulations in its hiring and employment practices and policies for any activity covered by this Agreement. The Provider shall comply with all state, federal, and municipal laws, regulations, and standards applicable to its activities pursuant to this Agreement including, but not limited to, the requirements imposed by Ind. Code 22-9-1-10 (non- discrimination), the provisions of Ind. Code 5-22-16.5 (disqualification for dealings with the government of Iran), and the provisions of Ind. Code 22-5-1.7 (requiring E-Verify for new employees and prohibiting employment of unauthorized aliens). Each of the foregoing provisions is incorporated herein as if set forth in full, and the Provider certifies that it is in compliance with each such provision and shall remain in compliance through the term of this Agreement. Pa 11. I1rug:j°j "' 'orl:rrla c. The Provider hereby agrees to make a good faith effort to provide and maintain a drug -free workplace. The Provider will give written notice to the City within ten (10) days after receiving actual notice that the Provider or an employee of the Provider within the State of Indiana has been convicted of a criminal drug violation occurring in the workplace. 12. Entire WgrecimAmendment: Anolicable Law. This Agreement sets forth the entire agreement and understanding between the parties as to the subject matter hereof, and merges and supersedes all prior discussions, agreements, and understanding of any and every nature between them. This Agreement may be amended only by separate writing, signed by authorized representatives of both the Provider and the City. This Agreement will be construed and interpreted according to the laws of the State of Indiana, and any dispute arising out of this Agreement or otherwise concerning the Provider's rendering of the Services will be resolved in the courts located in St. Joseph County, Indiana, unless the Parties mutually agree to a different method of dispute resolution. 13. Severi N Mom. All provisions of this Agreement shall be considered as separate terms and conditions, and in the event any one shall be held illegal, invalid or unenforceable, all the other provisions hereof shall remain in full force and effect as if the illegal, invalid, or unenforceable provision were not a part hereof, unless the provision held illegal, invalid or unenforceable is a material provision of this Agreement, in which case the Provider and the City agree to amend this Agreement with replacement provisions containing mutually acceptable terms and conditions. 14. For"ce"ce MiLure. The Provider shall not be responsible for any failure or delay in the performance of any obligation hereunder, if such failure or delay is due to a cause beyond the Provider's reasonable control, including, but not limited to acts of God, flood, fire, volcano, war, third -party suppliers, labor disputes or governmental acts. [Signature page follows.] IN WITNESS WHEREOF, the Parties hereto have caused this Agreement for Professional Services to be effective as of the Effective Date stated above. .,,SlbiCLAIII It `II 110 N. LLC °wa�adu'i!'dor�^ ( lj A►-iL � t nc ra.�v ............ pruUed one and' ide ly,A S 1 Ol ( � K E. ,1,,,,,.<'•.�e & �Le mid N.a, ap 1 �4 vac•(. L. r q qa `l i aiv. Stott lip Telephone Far CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORIKS y A. Gi"fot, President Suzanna Fritzberg, Member Therese J. orau, ember Elizabeth A. Maradik, Member James A. Mueller, Member 4 EXHIBIT A Proposal [See attached] EXHIBIT B Contractor Affidavit [See attached] GameTime c/o Sinclair Recreation Ua��, PO Box 1409 QUOTE meTimHolland, MI 49422-1409 #73352 Ph: 800-444-4954 Fax:616-392-8634 11/21/2018 All Parks All Freestanding City of South Bend Project #: P58929 Attn: Nick Gaul Ship To Zip: 46614 Parks & Recreation 321 East Walter Street South Bend, IN 46614 Phone: 574-235-5597 ngaul@southbendin.gov 1 Boehm Boehm Park 1 RDU Game Time - Swings with Seats $6,885.00 $6,885.00 (2) 5128 -- Expression Swing 3 1/2" X 8' (1) 12583 -- Ada Primetime Swing Frame, 3 1/2" Od (2) 12584 -- Ada Primetime Swing Aab, 3 1/2" Od (2) 17247 -- Adaptive Swing Safety Belt (2) SS 1483 -- Belt Seat 3 1/2"/8' & 10' High (2) SS8537 -- Adaptive Seat (3 1/2" /8' High) 1 RDU Game Time - Tri-Runner $12,117.00 $12,117.00 (1) 6243 -- Tri Runner 1 RDU Game Time - Sensory Wave Arch w/Gold $10,667.00 $10,667.00 pckg. (1) 3206 -- FS Sensory Wave Arch System (1) 4690 -- FS Arch Gold Sensor Package 1 6245 Game Time - RoxAll See Saw $9,852.00 $9,852.00 1 3205 Game Time - Spinning Sensory Wave Seat $1,062.00 $1,062.00 1 RDU Game Time - Fire Truck Spring Rider $890.00 $890.00 (1) 4882 -- Fire Truck Spring Rider (1) 4880 -- Inground Mount For Spring Rider 1 RDU Game Time - Dump Truck Spring Rider $951.00 $951.00 (1) 4883 -- Dump Truck Spring Rider (1) 4880 -- Inground Mount For Spring Rider 1 5035 Game Time -Custom Fiberglass Sign 1S $1,619.00 $1,619.00 102 4862 1 Game Time - 12" Playground Border $50.00 $5,100.00 1 River Manor River Manor Park 1 RDU Game Time - Swings with Seats $6,455.00 $6,455.00 (2) 5128 -- Expression Swing 3 1/2" X 8' (1) 12583 -- Ada Primetime Swing Frame, 3 1/2" Od (2) 12584 -- Ada Primetime Swing Aab, 3 1/2" Od (2) SS 1470 --Enclosed Tot 3 1/2"/8' High Page 1 of 5 GameTime c/o Sinclair Recreation PO Box 1409 Holland, MI 49422-1409 Ph: 800-444-4954 Fax: 616-392-8634 All Parks All Freestanding QUOTE #73352 11/21/2018 1 1 Coquillaird Coquillaird Park 1 RDU Game Time - Wrinkle Wall Orb $16,198.00 $16,198.00 (1) 6253 -- Wrinkle Wall (8 Panel) ll RDU Game Time - Access. Curb & Borders $3,462.00 $3,462.00 (1) 4858 -- Access Playcurb-W/Adap N (59) 4862 -- 12" Playground Border N Brownfield Brownfield Park 1 5112 Game Time - Skyrun Zipline 100' $15,062.00 $15,062.00 1 RDU Game Time - Playcurb border for Zip Line $3,774.00 $3,774.00 Area (74) 4850 -- 8" Playcurb Pkg 1 1 Boland Boland Park 1 RDU Game Time - OmniTri Net $23,970.00 $23,970.00 (1) 3137 -- Omnitri Net 1 RDU Game Time - RoxAll See Saw $9,852.00 $9,852.00 (1) 6245 -- RoxAll See Saw 1 RDU Game Time - Playcurb border $1,800.00 $1,800.00 I (36) 4862 -- 12" Playground Border l Walker Walker Park 1 RDU Game Time - Access. Curb & Borders $3,462.00 $3,462.00 (1) 4858 -- Access Playcurb-W/Adap (59) 4862 -- 12" Playground Border 1 1 Riverside Riverside Park 1 14912 Game Time - Thrive 450 $20,255.00 $20,255.00 1 13556I Game Time - Lat Pull Down (Single)- $3,817.00 $3,817.00 InGround Mount l 135551 Game Time - Chest Press (Single) - In -Ground $3,681.00 $3,681.00 Mount 1 13574 Game Time - Knee Lift Station $537.00 $537.00 Page 2 of 5 GameTime c/o Sinclair Recreation A"% k2 �, PO Box 1409 QUOTE ar We C7Holland, MI 49422-1409 #73352 Ph: 800-444-4954 A i .. „i, c�+o.ny Fax: 616-392-8634 11 /21 /2018 All Parks All Freestanding I Leeper Game Time - I RDU Game Time - Swings with Seats $6,885.00 $6,885.00 (2) 5128 -- Expression Swing 3 1/2" X 8' (1) 12583 -- Ada Primetime Swing Frame, 3 1/2" Od (2) 12584 -- Ada Primetime Swing Aab, 3 1/2" Od (2) 17247 -- Adaptive Swing Safety Belt (2) SS 1483 --Belt Seat 3 1/2"/8' & 10' High (2) SS8537 -- Adaptive Seat Q 1/2" /8' High) 1 3205 Game Time - Spinning Sensory Wave Seat $1,062.00 $1,062.00 1 4676 Game Time - Harmonic Chimes (set of 3) $2,766.00 $2,766.00 1 4682 Game Time - Jazz C Major $2,817.00 $2,817.00 1 5056 Game Time - Arch Swing $6,072.00 $6,072.00 2 6143 Game Time - Whirlwind Seat Straight (F/S) $615.00 $1,230.00 1 6243 Game Time - Tri Runner $12,117.00 $12,117.00 1 6245 Game Time - RoxAll See Saw $9,852.00 $9,852.00 1 Randolph Game Time - 1 RDU Game Time - Rand Swings $6,455.00 $6,455.00 (2) 5128 -- Expression Swing 3 1/2" X 8' (1) 12583 -- Ada Primetime Swing Frame, 3 1/2" Od (2) 12584 -- Ada Primetime Swing Aab, 3 1/2" Od (2) SS1470 --Enclosed Tot 3 1/2"/8' High (2) SS1483 -- Belt Seat 3 1/2"/8' & 10' High 38 4862 Game Time - 12" Playground Border $50.00 $1,900.00 1 38205 Game Time - Whirlin' Robin $3,909.00 $3,909.00 1 6246 Game Time - Solo Spinner $1,519.00 $1,519.00 1 RDU Game Time - Curbs $1,912.00 $1,912.00 (1) 4858 -- Access Playcurb-W/Adap (28) 4862 -- 12" Playground Border 33 4862 Game Time - 12" Playground Border $50.00 $1,650.00 2 ULTRASITE Game Time - 967-P4 $795.61 $1,591.22 Page 3 of 5 GameTime c/o Sinclair Recreation PO Box 1409 Holland, MI 49422-1409 Ph: 800-444-4954 A p s t wow C*mo`nY Fax: 616-392-8634 All Parks All Freestanding Does not include unloading or storage. Freight pricing assumes all items are pool shipped to single location at the same time. All other pricing shows discounts for USC pricing. Contract: USC Acceptance oftrotat"on: µ Gary Gilot -17 , /)� James Mueller Elizabeth Maradik Therese Doran Suzanna Fritzberg REQUIRED ORDER INFORMATION: Bill To: Venues Parks & Arts Karin Avam........_ Contact: nce Address: 321 E. Walter St, Address: City,State, Zip: �_....South Bend ' IN 46614 Tel: 574-299-4771 (For Accounts Payable) Email: kavance@southbendin.gov Page 4 of 5 SubTotal: Discount: Estimated Freight: Total Amount: P.O. No: 246798 Ship To: _....._.............. . � _. Venues Parks & Artsmmmmmm Contact: Nick Gaul Address: 1020 High St QUOTE #73352 11/21/2018 $240,922.22 ($26,119.62) $0.00 $214,802.60 Address: 1 City, State, Zip: �� _.-.�.�.._..........._........_ ' South Bend IN 4660 Tel: 574-235-5597 Exhibit B When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) ` TA l l3 01` r^, i e- k i r„ , ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in ■ the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Non -Collusion Non -Debarment Affidavit Non Fran Form Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. 1, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. 1 understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. 1 understand that violations hereunder may result in forfeiture of contractual payments. l hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this l9{ day of accr�pm0 1 b' (Sa tractor/Bidder Ifirml Signature of Contra �\ ctor/Bidder or Its Agent lJ1Ia►-y— f-ie11Lir rf l�Si Printed Name and Title Subscribed and sworn to before me this day of , 20 1 My Commission Expires�� otry ftrbi ic County of Residence 1;:7 SCOT T BAREMAN� Non -Collusion Non-Debarmeni Affidavit Non Iran Form NOTARY PUBLIC - STATE OF MICHIGAN COUNTY OF OTTAWA My Commission Expires Dec. 28, 2024 Acting in the County of .1' BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/06/2018 Name wPatrick Sherman Department VPA: Facilities & Grounds BPW Date 12/11/2018 Phone Extension 5601 m smmnmmnmmmmmmmmmri ✓,muuuuuumummwuw.rawaa emaeuP m... wy. MME51miumEffoowm'ummm yam �_....�...,.... � IT�w_ R� uired Prior to Submittal to Board g ® Attorne Name Clara McDaniels Controller ® 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 ® Michael Schmidt Check the Agreement ] Professional Services Bid Opening El Quote Opening Change Order No. [ Ease/Encroach. Other: QPA Purchase Tq riate Item T r ems— Rq uir for All Submissions issi Contract Proposal Resolution Bid Award D Req. to Advertise D Quote Award ❑ C/O & PCA No. ❑ PCA ❑ Traffic Control Rewired Information Company or Vendor Name Gametime Inc. New Vendor El Yes M No F-1 If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE [:] WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company ProjectPpg.r es Pro ram: Phase 2 mm_Project Number10762018g Funding Source Account No. Amount Terms of Contract Purpose/Description Amount of El Addendum ❑ Title Sheet Park Bond Series I 471-1137-452.42-01 _214,802.60 _ QPA Purchase: US Communities Contract #201#2017001�134 QPA Purchase of la round a ui ment as art of2� 019 arks upgrade pro ..ram El Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) Increase Decrease Previous Amount Current Percent of Change New Amount Total Percent of Change: Copy Original El F-1 ❑ ❑ Dispersal After Approval