Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 1, 2016 <br />Name <br />Sarah Heintzelman <br />Department <br />Comm Inv <br />BPW Date <br />September 13th, 2016 <br />Phone Extension <br />5842 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for Ai/ Submissions <br />❑ Agreement ® Contract ❑ Proposal ❑ Addendum <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Chg Order No. <br />Ease./Encroach. <br />Other: <br />Company or Vendor <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 />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control ❑ Resolution <br />❑ Claim <br />Required Information <br />Northern Indiana Workforce Board (NIWB) <br />L_J Yes U If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Pathways Program <br />408-1001-460-31.06 <br />$100, 000 <br />Training programs to train necessary skills to under skilled <br />workers to meet labor needs in the community. <br />For Change Orders Only <br />Amount of " Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy <br />® Sarah Heintzelman, Community Investment <br />® Judy Love, Community Investment <br />® Jacob Alexander, Community Investment <br />