HomeMy WebLinkAboutOpening of Quotes - Tree Nursery ReQuote Proj No 125-017R - Acorn Landscapingo� tint' Tyr e�;
CITY OF SOUTH BEND, INDIANA w
CONTRACTOR'S QUOTE FOR PUBLIC WORK
1865
PROJECT NAME:
PROJECT NO.
QUOTES DUE
Date:
Address:
City/State/Zip
Urban Tree Nursery Site Improvements
125-017R
Tuesday, July 8, 2025 at 9:30am
(Must be completed for all quotes. Please type or print)
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 accordande with plans and specifications prepared by:
The City of South Bend, Department of Public Works
and dated 7 — 7 �� S� ] for the sum of (enter the Total o�e as shown on the Proposals 00
d�lu.nG((4d n/4-�-n�1�P%iter�Sar�C� Or1p huI,d�ec��¢�teti`(('A,� ars ($ oC l 7 / )
(Enter Sum of Total 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 South Bend. If the quote is to be awarded on a unit basis, the
itemization of the units shall be shown on a separate attaghment. By /eb n�w4d,
r n� & ,(Signs ure)
(Printed Name of Person Signing)
ACCEPTANCE
The above quote is accepted this day of
Subject to the following conditions:
BOARD OF PUBLIC WORKS
President
Members
20
Version 1/3/2025 Page - 20 Public Works Quote
'ot fllbE
QUOTEIPROPOSAL
CITY OF SOUTH BEND
f NAS
PROJECT NAME Urban Tree Nursery Site Improvements
PROJECT NO. 125-017R
QUOTES DUE Tuesday, July 8, 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
$
2
Excavation / Grading (Pavilion, Staging
1
LS
ao2
$ g0 ZOZ
Areas and Includes tillin Grow Rows
3
Concrete, 4" (Under Pavilion)
93
Sys
75,
$ MIS 0
F�7Pavilion
#53 Compacted Aggregate (Under
210
TON
//�o�
S-
$ // o
3(v5�
and Staging Areas —10 900SF
lS�
ALLOWANCE #1: Irrigation Hook -Up
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Allowance 1: Connect to existing 2"
irrigation main at the Half Moon site,
including a new controller. Water
connections and controls to be located at
the Northeast corner of the site.
5
Bidder shall provide price to provide and
1
LS
$25.000
install PVC Water Lines from Irrigation
Main to Growing Rows.
Bidder shall provide price to provide and
install Drip Irrigation Hoses from PVC
Connections at Growing Rows
ALLOWANCE #1 TOTAL $25,000
BASE BID TOTAL j3q _Q:V_
Alternate 1: Block Wall Storaae Corral
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Concrete Block Wall: Bidder shall provide
6
price to provide and install "Concrete
1
LS
//-- 430
Ip�(9S
$ ad
2— 6o S
Block" walls 6'x2'x2' Block).
Total Amount for Alt. 2 Quote
$ I Z&,5-
Alternate 2: Raised Beds
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Wolmanized Wood (Raised Beds): Bidder
o
shall provide price to provide and install
Wolmanized wood raised beds, including all
00
//��
7
1
LS
3��W�
$
associated framing, fasteners, filter fabric,
)=
and structural support as identified in the
tans. 5 Beds — 4'xl D'x10"
8
Pea Gravel (Raised Beds)
15
TON
3
a Y `7 r
Total Amount for Alt. 3 Quote
$ S�{C,i b O
Alternate 3: Geotextile Fabric
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Geotextile Fabric, Staging Areas: Bidder
9
shall provide price to provide and install
10,070
SF
$
geotextile fabric at staging areas as
identified in the plans.
Geotextile Fabric, Growing Rows: Bidder
10
shall provide price to provide and install
45,600
SF
$ U
geotextile fabric at growing row as identified
in the plans.
Total Amount for Alt. 4 Quote
S
Alternate 4: Pavilion
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
11
Pavilion, Monoslope 20'x30'
1
EA
$
Total Amount for Alt. 5 Quote
$ 6 °
Alternate 5: Tree Placement
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Tree Placement — Transport of 100 nursery
12
trees from Elbel Nursery, repotting, and
1
LS
/ g n�/ oo
$
placinginto Grow Rows.
O
C7 (s�
Total Amount for Alt. 6 Quote
$ 8
Firm:
COf- (� LaV ,, ((, DOAC, L( C
Address: S680 W eE
pp
City/StatelZip: oLk� k &,A N Telephone Number:
Fax Number:
(Signature)
(Printed Name of Person Signing)
When the prospective Contractor is unable to certify to any of the statements below, it shall atlacls 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
,st os h ) SS:
COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affairs 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 investmcnt
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 activitics 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
version 1/3/2025 Page - 29 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 LC, 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, 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
WBE 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 1IM025 Pape - 30 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. 5-16-
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. 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 make 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 alTtrin under the penalties of perjury that the facts and information contained in the foregoing bid for public
works are true and correct.
Dated this M daN of , 20A5
r7
Contractor/Bidder (Finn)— &WAid, ,Q y�,,
/L�✓
Signature of Contractor/Bidder or Its Agent
_Aridrm 4fs hard Mimhe -
Printed Name and Title If
Subscribed and sworn to before me this day of k , 202E
My Commission Expires _
Notary Public
n
County of Residence (`
Mezand,aa Harnendez
Notary Public Sabi tStata of Indian■
6L joppn Cwnty
CommllNon NumbetWOTIa11
my Con iris oe Ex" IM2017
Version 113=25 Papa , 31 Public Works Quote
J A Ili R�
CITY OF SOUTH BEND = r
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: 125-017R WBE Participation Goal
Project Name: Urban Tree Nursery Site Improvements
Bidder
BYn an a Q l n Q I n M Q�- &o(o,A }
(Signature) iUe (Date)
WBE Firm _k—) �-S C1'`E,4-rJ 8 To S. I C .
Owner or Contact at WBE Firm
Telephone S )C- o2 0'V —17ax: N I Email �C/ LA
TYPE OF WORK SOLICITED FOR THIS PROJECT:
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:
Gc-,-'
�x nl ti
CITY OF SOUTH BEND �.
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN - V
FORM WBE-2,0 w ,
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 125-017R Date
Project Name. —Urban Tree Nurse Site Improvements
Irl
Bidder: end'y\
Contact Person.
eaa P ksc,ar
Telephone: S 7{-,?8� 69s0
Address: SG gb
City: State. Zip:
Email: /n7CD LACGy"nlQn SC'Gt�GYY)
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 M WBEs 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: h :l/www.in. ovfidoa/.
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.
/�
AMP
__i[http_-//www_in.gov/idoa)
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
I affirm that I have made good faith efforts to select portions of the contract work to be
&kl
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�
I affirm that I advertised in general circulation and/or trade association publications
concerning subcontract opportunities and allowed WBEs reasonable time to respond to
such advertisements.
�-
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.
I 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
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
W—
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.
I affirm that I have made good faith efforts to assist interested WBEs in obtaining
necessary equipment, supplies, materials, or related assistances or services, where
appropriate
I affirm that I 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.
"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.
'J
CITY OF SOUTH BEND yf,
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-1.0
WBE UTILIZATION PLAN
This completed form should 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. 125-017R Project Name: Urban Tree Nursery Site Improvements
Total Bid -�7 a o
Bidder. F ,LLCAmount: 3Y� �36 / WBE Goal: c2,q IO
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
I
1 �ro5
�61 42
P999rga I&,,ely
Id g0`71,3Z
3. do
3/
Submitted by: A lhmwJAdIA 1eL&JA1t6C_ 7/-7/�Oa5
Print Name Signature Date
***Goals should be calculated based on the Base Bid only.***
,111 AE
1 I,
CITY OF SOUTH BEND �±
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ;Q -
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 verity whether any listed
minority or woman business meets the MBE qualifications. Attach additional pages If necessary.
PAGE OF
)—
Project Number: 125-017R MBE Participation Goal o
Project Name: Urban Tree Nurse Site Improvements
Bidder.
By �� /� �./C/a / I �Q i1Q Ill rA (L%1'LK/r?% _ I/ o a ,
(Signature) 4TitIeV (Date)
MBE Firm 14 C la �' -�-, l 14-�a 1 c- h`�(_ e-
Owner or Contact at MBE Firm j� ,0 r-,,
Telephone:%(! �3 QQ71 Faux -�7��
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:
1�
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN - =
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 particlpatlon. _
Project Number 125-017R Date �' 'v? S
Project Name
Bidder.
Urban Tree Nursery Site Improvements
Contact Person f1'1drea- /z, 1,yMwV J
Address.
C
Telephone
l r
City° ��^ State 7 A Trp;
Email, i n r66) Gi Cprn/Qn ,ScCcnQf'f. CDC
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,
RE43UIRE 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 Enterpnse
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: httJlwww in govAdoaf.
GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION
The bidder
in the awarded
shall initial each item below, as evidence of its good faith efforts to obtain MBE participation
contract.
I affirm that I reviewed the City of South Bend's Minority and Women Business Enterpnse
Inclusion Program Plan and the Indiana Department of Administration's certified list of
Indiana Minority and Women Business Enterpnses, found on their website
httl/www in ovlidoa .
�N
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.
�'JilfV
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
�I
concerning subcontract opportunities and allowed MBEs reasonable time to respond to
such advertisements.
PO
I affirm that I performed any and all necessary steps to provide written notices in a manner
reasonably calculated to inform MBEs of subcontracting opportunities and allowed
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
subcontracL
nA .
I affirm that I have made good faith efforts to assist Interested MBEs in obtaining bonding,
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.
9. Name, address, and telephone number,
Z 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.
.a i\ ill Gf,
a
CITY OF SOUTH BEND !J�
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
Bidder:
125-017R
Project Name
Urban free Nursery Site Improvements
Total Bid Amount: `� ?j�% 3� 7 MBE Goal: /o
Page 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
Gomponert
Percentage
of Total
BkUProposal
-Mvl-C SL� C
C-0���
�e
e ?S
Submitted by: & ire
r Scv�GI'/'C1�/
`'"'"
_ 7�7��,��
Print Name
Signature
Date
***Goals should be calculated based on the Base Bid only.***
Date:
Name:
BPW Date:
7/8/2025
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
6/30/2025
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
Information
❑ Yes ❑ If Yes, Approved by Purchasing
❑ No
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
Open quotes for revised project
For Change Orders Only
Amount of ❑ Increase $
❑ Decrease ($ )
Previous Amount
Current Percent of Change
New Amount
Increase
Decrease
Increase
Total Percent of Change: Decrease
Time Extension Amount:
New Comnletion Date: