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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Aril 2.5 019 <br />_.............. y <br />Name Alicia Czarnecki Department EnQineerinS <br />BPW HH„� Date tension 5903 <br />� � NI,a l' 4 2Ii l i�" Phone Extension <br />Rewired Prior to Submittal to Board <br />_—...._ _. ...... _....._...._ _..................... .................... <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the Appropriate Item Type — <br />El _gr ❑] Professional Services Agreement Contract <br />uired �� �)wrAll Submissions <br />�..........._ <br />❑ <br />Open Market Contract <br />F-1 Amendment/Addendum <br />Bid Opening <br />Bid Award <br />uote Opening <br />Q p <br />® Quote Award <br />E] <br />Proposal Opening <br />❑ <br />C/O & PCA No. <br />❑ <br />Chg. Order, No. <br />Traffic Control <br />�] Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />uired Information <br />LJ Proposal <br />E] Special Purchase, QPA <br />❑] Req. to Advertise <br />EJ Reject Bids/Quotes <br />R PCA <br />❑ Resolution <br />�] Ease./Encroach <br />K & R Tree Service <br />Yes If Yes, Approved by Purchasing <br />❑] No <br />❑ MBE ❑ WBE Completed E-Verify Form Attached <br />2019 Tree and Stump Removal <br />119-012 <br />MVH <br />202-0619-431.31-06 <br />$27,055.00 <br />❑ Title Sheet <br />F] Yes <br />❑ No <br />Remove trees and stumps for sidewalk; replacement at various locations in <br />South Bend. <br />For Ck�rtrr �c Orders Or�rl <br />Amount of Increase $ <br />........... _.w..........,................_.....�.,.,.,.,.,.,.,. m....................�.�.�...,,,,,, . <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease �(% <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease /o <br />g <br />Time Extension Amount: <br />New Completion Dat <br />e: <br />_..........,...,_...... W <br />