HomeMy WebLinkAboutOpening of Quotes - Studebaker Fountain Water Improvements Proj No. 121-032 - Culligan WaterBOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date: 1-12-2022
Name: Sarah Beam Department of Public Works – Engineering Division
BPW Date: 1-25-2022 Phone Extension: 9805
Required Prior to Submittal to Board BPW Attorney X Attorney Name Clara McDaniels
Dept. Attorney Attorney Name Clara McDaniels
Purchasing Michael Schmidt
Check the Appropriate Item Type – Required for All Submissions
Professional Services Agreement Contract Proposal
Open Market Contract Amendment/Addendum Special Purchase, QPA
Bid Opening Bid Award Req. to Advertise Title Sheet
Quote Opening Quote Award Reject Bids/Quotes
Proposal Opening C/O & PCA No. PCA
Chg. Order, No. Traffic Control Resolution
Other: Ease./Encroach
Required Information
Company or Vendor Name
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE
WBE Completed E-Verify Form Attached Yes
No
Project Name Studebaker Fountain Water Improvements
Project Number ENG: 121-032 / PROJ00000250
Funding Source Fund 201 Park Capital; and Fund 452 Land Improvements
Account No. 201-273-443001; and 452-444000
Amount
Terms of Contract
Special Contract Provisions
Purpose/Description The Division of Engineering requests the Board of Public Works open and
receive quotations for the subject project at its 1/25/2022 regular meeting.
For Change Orders Only
Amount of
Increase
Decrease
$
($ )
Previous Amount $
Current Percent of Change:
Increase
Decrease
%
( %)
New Amount $
Total Percent of Change:
Increase
Decrease
%
( %)
Time Extension Amount:
New Completion Date:
TRAFFIC CONTROL AND OCCUPANCY REQUEST
City of South Bend – Division of Engineering
227 W Jefferson Boulevard, Ste 1316
South Bend, IN 46601
Name of Contractor/Company:
Name of Applicant:
Phone: Email Address:
On-Site Contact: Phone:
Requested Dates (mm/dd/yyyy): _______ /_______ /20_______ to _______ /_______ /20_______
Time of Work: _____________________ to ____________________
Location of Work: Entire Street Travel Lane Parking Lane
Sidewalk Tree Lawn Alley
Type of Work: Excavation/Boring (Also requires Excavation Form)
New Drive Approach (Also requires Curb Cut Application)
Sidewalk
Address of Project:
Project Boundaries:
Description of Work:
Traffic control plan including detour map and traffic devices.
Communication (letter, door hanger, signs, etc.) to affected property owners
Failure to use traffic control for traffic restrictions or closures will result in stop w ork
orders and/or delay in permitting. This Occupancy Permit Request is non-transferable. A
signature subjects the named contractor/permittee to all applicable rules, duties and
obligations imposed by the South Bend Municipal Code and to all regulations imposed by
the City’s Board of Public Works.
Signature of Applicant: Date:
Applications should be dropped off to the City’s Engineering Office or emailed to
rowpermitsoffice@southbendin.gov. For questions, contact Liz Horvath at 574.235.9254.
DEADLINE: DUE FIVE BUSINESS DAYS PRIOR TO PROJECT START DATE
PROJECT INFORMATION
OFFICE USE ONLY:
Date Received: Fee Paid: Approval Date:
INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION:
APPLICANT INFORMATION
EXCAVATION PERMIT REQUEST
City of South Bend – Division of Engineering
227 W Jefferson Boulevard, Ste 1316
South Bend, IN 46601
Name of Contractor/Company:
Phone: Email Address:
Date of Work (mm/dd/yyyy): _______ /_______ /20_______ to _______ /_______ /20_______
Time of Work: _____________________ to ____________________
Location of Work Address:
Type of Work: Cable Electric Fiber Gas Manhole repair
Sanitary Sewer Water Other
Type of Cut: Number of Cuts Boring Trenching
Cut Location: In Street Tree lawn/sidewalk right-of-way
Description of Work:
Excavation in right-of-way WITHOUT a permit will result in a stop work order and/or
delays in permitting. Emergency excavations must be called into the Permits Office at
574.235.9254 no later than noon the following day.
This excavation permit request is non-transferrable. A signature subjects the named
contractor/permittee to all applicable rules, duties and obligations imposed by the City of
South Bend Municipal Code and to all regulations imposed by the City of South Bend’s
Board of Public Works.
Signature of Applicant: Date:
Completed application should be dropped off to the City’s Engineering Office or emailed
to rowpermitsoffice@southbendin.gov. For questions, contact Liz Horvath at
574.235.9254.
APPLICANT INFORMATION:
PROJECT INFORMATION:
OFFICE USE ONLY:
Date Received: Fee Paid: Approval Date:
EXCAVATION PERMIT REQUEST (continued)
First Subcontractor
Name of Subcontractor/Company:
Name of Contact:
Phone: Email Address:
Second Subcontractor
Name of Subcontractor/Company:
Name of Contact:
Phone: Email Address:
Third Contractor
Name of Subcontractor/Company:
Name of Contact:
Phone: Email Address:
LIST ALL OTHER CONTRACTORS