PSA - John Jay College of Criminal Justice

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Name 11/10/2016 Department Innovation and Tech BPW Date 11/22/2016 Phone Extension 6018 Danielle Fulmer Kequired Prior to Submittal to Board Legal ® Attorney Name Michael Schmidt Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing Check the Appropriate Item Type — Re uired for All Submissions ❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum ® Professional Services ❑ Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Change Order No. ❑ C/O & PCA No. ❑ PCA ❑ Ease/Encroach. ❑ Traffic Control ❑ Other: Required Information Company or Vendor Name John Jav College of Criminal Justice New Vendor ® Yes ❑ No ❑ If Yes, Approved by Purchasing MBEM/BE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name National Network for Safe Communities Membership Scoping Visit Project Number Funding Source Department of Innovation and Technology Account No. 404-0672-415-31-06 Amount $ 2500.00 Terms of Contract Net 30 Purpose/Description Employees of John Jay will visit South Bend to conduct a needs assessment for a potential future membership contract to support ongoing implementation of the Group Violence Intervention John Jay will pay all staff time for the site visit and Innovation and Amount of ❑ Increase ❑ Decrease Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ® ❑ ❑ ❑ ❑ ❑ Required Contractor's Certification Form Attached (Non- lusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran, etc. For Change Orders Dispersal After Approval Danielle Fulmer