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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />WITIRT-T, <br />Department DCl <br />0 Agreement <br />LJ Contract LJ Proposal H Addendum <br />El Professional Services <br />n Resolution <br />• Bid Opening <br />El Bid Award El Req. to Advertise El Title Sheet <br />• Quote Opening <br />El Quote Award <br />• Change Order No. <br />❑ C/O & PCA No. F1 PCA <br />n Ease/Encroach. <br />❑ Traffic Control <br />15ZI Other: Amendment <br />Company or Vendor Name Department of Community Investment <br />New Vendor E] Yes M No El If Yes, Approved by Purchasing <br />MBEANBE Contractor [:] MBE ❑ WBE <br />MBE/WBE Contractor Requested Z Noo Yes Name ofCompany <br />_ <br />Project Name CDBG Activity Delivery <br />Project Number 17-C-98 <br />Funding Source Community Development Block Grant (CDBG) <br />Account No., 212.1001.460.3930 <br />Amount $174,868 (increase from $74,787 to $174,868) <br />Terms of Contract 1/01/17 — 12/31/17 <br />Purpose/Description Increase contract amount by $100,081 so that all expended CDBG <br />activity delivery costs from 2017 ma V be drawn, additional funds are <br />from expired 2017 CDBG Admin contract <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of increase $ <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />F] <br />El <br />1:1 <br />Judv Love <br />Dispersal After Approval <br />