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BOARD OF PUBLIC WORI{S <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/6/2018 <br />J <br />Agreement <br />LJ Contract U Proposal U Addendum <br />® <br />Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ <br />CIO & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ <br />Traffic Control <br />Other: <br />Company or Vendor Name New Avenues <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIVVBE Contractor ❑ MBE ❑ WBE <br />MBEIVVBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name Employee Assistance Program (EAP) <br />Project Number <br />Funding Source Health Insurance Fund <br />Account No. 711-0401-671-34-13 <br />Amount See Exhibit A; $3.55 PEPM for Non -Public Safety employees; $4.05 <br />PEPM for Public Safety employees. <br />Terms of Contract Agreement is for a one year period, option to renew. <br />Purpose/Description This is a renewal contract with the City's Employee Assistance <br />Program provider. Services will include: short-term counseling, EAP <br />orientation training, telephonic consultation,.management referral <br />program, critical incident response, fitness for duty evaluations <br />work -life resource center, brochures, reports, and 4 hours of <br />trainingslworkshops. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. 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 />Dispersal After Approval <br />Copy Original <br />® ❑ Jennifer Hockenhull and Kyra Clark <br />❑ ❑ <br />