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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />INK-95111MU-0 <br />Name Lory Timmer Department DC1 <br />BPW Date Phone Extension 5841 <br />.... ....... <br />_quired Prier to 06*jri% rd.-, <br />Legal ❑ Attorney Name Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Agreement <br />F-1 Professional Services <br />F-1 Bid Opening <br />F-1 Quote Opening <br />D Change Order No. <br />E] Ease/Encroach. <br />F-1 Other: Amendment <br />Contract <br />mama=s <br />❑ Req. to Advertise, E] Title Sheet <br />Company or Vendor Name <br />AIDS Ministries/AIDS Assist of North India,nq,.. Inc. ,, <br />New Vendor <br />❑ <br />Yes E No n If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />MBE n WBE <br />MBEANBE Contractor Requested M No n Yes Name of Company <br />Project Name <br />Emergency Shelter Operations & Rapid Rehousing Activities <br />Project Number <br />18-JE-02 <br />Funding Source <br />Emergf�nqy Solutions gran <br />Account No. <br />212,1001.460.39.30 <br />Amount <br />$21,000 <br />Terms of Contract <br />1/01/18 - 12/31/18 <br />Purpose/Description Subsidize costs of providing emergency shelter and rental <br />assistance for AIDS ministries clients <br />Z 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 />z <br />❑ J <br />11 <br />El <br />F] <br />El <br />Love <br />Dispersal After Approval <br />