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HomeMy WebLinkAboutOpening of Quotes - Tree Nursery Quote Project No. 125-017 - Acorn LandscapingCITY OF SOUTH BEND, INDIANA , < CONTRACTOR'S QUOTE FOR PUBLIC WORK PROJECT NAME: Urban Tree Nursery Site Improvements PROJECT NO. 125-017 QUOTES DUE Tuesday, May 13, 2025 at 9:30am (Must be completed for all quotes. Please type or print) Date: �5'12'dS Firm: kun tq-nckSec�-,pa✓►e, LLC Address: 36SO W QsT M /p City/State/Zip:0.1 'hY�A , TA)Ielephone Number. Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: the City of South Bend, Indiana, in accordance with plans and specifications prepared by: The City of South and dated S— i (Enter Sum of of Public Works —d ] for the sum of (enter the Total Quote as shown on the Proposal) e71� jroi�hree�aY6�1(�-yi(A'Nv/Ott ($ 3311-3co, 2-c) ) Quote plus Alternates shown on Proposal) (Numerical) If alternative quotes apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of Sou en . f the quote is to be awarded on a unit basis, the itemization of the units shall be shown on a seoarat attachmen By 0 Person ACCEPTANCE The above quote is accepted this day of 20 Subject to the following conditions: BOARD OF PUBLIC WORKS President Members Version 1/3/2025 Page - 21 Public Works Quote QUOTE/PROPOSAL > CITY OF SOUTH BEND PROJECT NAME Urban Tree Nursery Site Improvements PROJECT NO. 125-017 QUOTES DUE Tuesday, May 13, 2025 at 9:30am Base Bid Items: Utility Connections and Grading Work item No. —Description Quantity Unit Unit Price Total Amount 1 Mobilization / Demobilization 1 LS I l o U,00 $ /l o00 2 Excavation / Grading (Pavilion, Staging Areas, and Includes tilling Grow Rows) 1 LS elzl $ 7 / 7 1, o 3 Demolition Utilit Cut Pavement Removal (Utility ) 1 LS .: $ (�? Y o , 0o 4 Concrete, 4" (Under Pavilion) 93 SYS (Do$ P3 ,0a 5 Asphalt Patch (Utility Cut for Water Line) 1 LS 7 " ,3(:D $ 7 o7�C�f 6 #53 Compacted Aggregate (Under Pavilion and Staging Areas — 10,900SF 210 TON `/" 62 � $ � 7 Domestic Water Line, 3" DIP 32 LF "� $ 1 / q0V 8 Water Meter Pit 1 EA qR70 $ 9 70 0 CI 9 Pavilion, Monoslope 20'x30' 1 EA $ �� 10 Tree Placement — Transport of 1000 nursery trees from Erskine Nursery, repotting, and placinginto Grow Rows. 1 LS �� `av 6 / 17(t2 c� Total Amount for Base Quote $ a 7 Q IS P Alternate 1: Irrigation Hook-up Item No. Description Quantity Unit I Unit Price Total Amount 1" PVC Water Line and Connections: 11 Bidder shall provide price to provide and $ install PVC Water Lines from Water Tap to Growing/6 Rows / ` / (Q Drip Irrigation Water Line (Hose, Connections, and Valve Box): Bidder shall 12 provide price to provide and install Drip 1 LS Ic $ Irrigation Hoses from PVC Connections at Growing Rows _���� Total Amount for Alt. 1 Quote $ Alternate 2: Block Wall Staraae Corral Item No. -.Description Quantity Unit Unit Price Total Amount Concrete Block Wall: Bidder shall provide 13 price to provide and install "Concrete Block" walls 6'x2'x2' Block). 1 LS / (�? $ Total Amount for Alt. 2 Quote $� w 0 Alternate 3: Raised Beds Item No. Description Quantity Unit Unit Price Total Amount Wolmanized Wood (Raised Beds): Bidder shall provide price to provide and install 14 Wofmanized wood raised beds, including all associated framing, fasteners, filter fabric, 1 LS `'7 �O 6 / and structural support as identified in the cans. 5 Beds — 4'X10'x10" 15 Pea Gravel (Raised Beds) 15 TON 16_S 161:N 7 S' Total Amount for Alt. 3 Quote $ / S, Alternate 4: Geotextile Fabric Item No. —.Description Quantity Unit Unit Price Total Amount Geotextile Fabric, Staging Areas: Bidder 16 shall provide price to provide and install geotextile fabric at staging areas as 10,070 SF j identified in the plans. (� lS� Geotextile Fabric, Growing Rows: Bidder 17 shall provide price to provide and install geotextile fabric at growing row as identified 45,600 SF �l 7 O $ f in the plans. Total Amount for Alt. 4 Quote $ S Firm: Address: LL C e-F City/State/ZipS&OMN&,(�_TYU Z166 f i Telephone Number: 283 '-69S(f� Fax Number: O By �i (Signature), A �( tJ(''`4 (Printed Name of Person Signing) X When the prospective Contractor is unable to certify' to any of lite 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) STATE OF Texas ) ) SS: Bexar COUNTY ) 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 § 5-22-16.5-5, 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 00 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 Version 1/3/2025 Page - 30 Public Works Quote 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. & Persons, firms, 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 contract or employment, or any matter directly or indirectly related to contracting or employment because of race, sex, religion, color, national origin, ancestry, gender expression, gender identity, sexual orientation, or due to age 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 will consider the Contractor's good faith efforts to obtain participation by those subcontractors 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. Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE; however, they may not unlawfully discriminate against said MBE/WBE. On goal -eligible contracts, Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the Contractor has made good faith efforts to obtain participation from MBE and ATE subcontractors. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor 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 to 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. 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. Version 1/312025 Page - 31 Public Works Quote I, 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. 5-15- 8-1). 1 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. I 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 ,snake a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. I hereby affirm under the penalties of peKiury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this 13th day of May , 2025 Acorn Landscaping,LLC Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent Jeffrey Ritschard , Member Printed Name and Title Subscribed and sworn to before me this 13th day of May 2025 My Conunission Expires 10/21/2028 441a��� Nota Publicof Texas County of Residence I jky ll(PC, ��/fi/l Jesse McCollough r= f C' }=-_ bb * c P ID NUMBER 135138321 pF t��� COMMISSION EXPIRES 11JIIIIIII October 21, 2028 Bexar Electronically signed and notarized online using the Proof platform. Version 1/3/2025 Page - 32 Public Works Quote 1316 COUNTY -CITY BUILDING a PHONE 574/ 235-9251 227 W. JEFFERsoN BOULEVARD it3 FAX 574/ 235-9171 SOUTH BEND, INDIANA 46601-1830 TDD 574/ 235-5567 CITY OF SOUTH BEND, JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: To: From May 12, 2025 All Plan holders Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: Urban Tree Nursery Site Improvements Project Number: 125-017 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT FOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. 9 Company: Authorized Signature: Date: �" f 01—a Version 4/2/2015 /�s%trxiJ CITY OF SOUTH BEND'`ti, MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.1 WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. it is the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. Attach additional pages if necessary. PAGE / _OF�_ Project Number: 125-017 WBE Participation Goal 3. 97 %® Project Name: Urban Tree Nursery Site Bidder/ "'i 'Se � Ki T-�,k By: re) WBE Firm 9 �SG kard Bras, IA)C', Owner or Contact at WBE Firm Ch e I l e- b c>/n j A K L- L- i 1 2� 1 Telephone: S7 q , - C- q 7 ax: bipl, Email: r� �-12Oqi' � i� C �-z -Coot TYPE OF WORK SOLICITED FOR THIS PR-i PROJECT:' Ex cG, L)(J f-�qr\ RESULTS OF CONTACT WITH THE WBE FIRM: WBE Firm Owner or Contact at WBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE WBE FIRM. - fS`Y'�GTif 1\�y\ CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN! FORM WBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain WBE participation. Project Number: 125-017 Project Name: Urban Tree Nursery Site Improvements Bidder: cc (.. ,Y\ �c p,La LZ C Contact Person: �-�' e,+Sc k a r 6A Address: City: Email: Date: 5 ! 2 _C95— Telephone: _< To determine whether a bidder has demonstrated good faith efforts to reach the WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below: EVIDENCE OF GOOD FAITH EFFORTS WBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: htt ://www.in. ov/idoa/. GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (http://www.in.gov/idoa). I affirm that I have made good faith efforts to select portions of the contract work to be performed by WBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate MWBE participation. I affirm that I have made good faith efforts to solicit through all reasonable and available means the interest of all WBEs in the scopes of work of the contract. I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform WBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed WBEs reasonable time to respond to e such advertisements. A I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform WBEs of subcontracting opportunities and allowed sufficient time for WBEs to participate effectively. jJ p 1 affirm that I followed up on initial solicitations with interested WBEs. I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding, lines of credit, or insurance as required by the City or the bidder, where appropriate. y <. CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.0 ` EVIDENCE OF GOOD FAITH FFFnRTs I affirm that I have made good faith efforts to assist interested WBEs in obtaining 1� T1 necessary equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that 1 did not reject any WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the WBE was unqualified to perform the job. *P d roper emonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 WBE UTILIZATION PLAN i ms compieTea Torm snouia be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. ***Goals should be calculated based on the Base Bid only.*** Project Number: 125-017 Project Name: Urban Tree Nurse Site Improvements Total Bid Bidder: CC3Y s� (-c.y� 5�c� (,vex Z Amount: T) ©� ,�� WBE Goal: p Page_�__of___ Name & Address of WBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposa Ica i CSC i � j � • he l I D�ir�;C3,1< X CcA �-� U� c� �j�g /U a° o Zc')� `7,C�fi 40 } Submitted byPA C�� Print Name Si ure ***Goals should be calculated based on the Base Bid only.*** Date -s�ii:.rfr aF•� CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.1 MBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. Attach additional pages if necessary. PAGE_I OF�_ Project Number: 125-017 MBE Participation Goal 1. 37 C� Project Name: Urban Tree Nursery Site By: (Title) 11 MBE Firm 4 ,1 S " (f (G5� j —/2.-;? (Date) Owner or Contact at MBE Firm �- P' Telephone: -71/-�q Fax: Email: cif C/a5-S cc171 TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: MBE Firm Owner or Contact at MBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: /�j[�Tft'\\ CITY OF SOUTH BEND` MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN1a •1 ,.. EiCi � 1 Z/ FORM MBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBE participation, Project Number: 125-017 Project Name: Bidder: Contact Person: Address: City: Urban Tree Nursery Site Improvements Date: IS— 12_C � Email: Q � ' -g C kn e czyyl r To determine whether a bidder has demonstrated good faith efforts to reach the MBE utilization goal set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: EVIDENCE OF GOOD FAITH EFFORTS MBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: httg://www.in.ggvi/iiadoai/. GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain MBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website �1 http://www.in.gov/idoa). I affirm that I have made good faith efforts to select portions of the contract work to be performed by MBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate MBE participation. I affirm that I have made good faith efforts to solicit through all reasonable and available means the interest of all MBEs in the scopes of work of the contract. Q I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform MBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed MBEs reasonable time to respond to such advertisements. 1 affirm that I performed any and all necessary steps to provide written notices in a manner 70 reasonably calculated to inform MBEs of subcontracting opportunities and allowed kJ sufficient time for MWBEs to participate effectively. I affirm that I followed up on initial solicitations with interested MBEs. I affirm that I negotiated with interested MBEs in good faith, including providing such MBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested MBEs in obtaining bonding, Ise lines of credit, or insurance as required by the City or the bidder, where appropriate. CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS I affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that I did not reject any MBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each MBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBE was unqualified to perform the job. *Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. f4 �GTFI �iJ CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN;. FORM MBE-1.0 MBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. ***Goals should be calculated based on the Base Bid only.*** Project Number: 125-017 Project Name: Urban Tree Nursery Site Improvements Bidder: -O m ' -� otal Bid Amount: 0 77, o lS MBE Goal: s 7 1 - Page I of / Name & Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal Submitted by. e �� PAs c�vxk ( Print Name Sign e ***Goals should be c culated based on the Base Bid only.*** Date Date: Name: BPW Date: 5/13/2025 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM 5/5/2025 Gemma Stanton Department of Public Works — Engineering Division Phone Extension: 9083 Required Prior to Submittal to Board BPW Attorney X Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑� 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 F-1 Other: I —I Ease./Encroach Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Special Contract Provisions Purpose/Description Amount of ❑ El Previous Amount Current Percent of Change New Amount Total Percent of Change: Time Extension Amount: New Comnletion Date: Information ❑ Yes ❑ If Yes, Approved by Purchasing ❑ No E] Yes ❑ WBE Completed E-Verify Form Attached ❑ No Urban Half Moon Tree Nursery n/a USDA Urban & Community Forestry Grant - 212-10-101-132-439300 PR#00040816 Unit Construction of Half Moon Tree Nursery at Ignition Park Increase Decrease Increase Decrease Increase Decrease