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Date <br />Name <br />130AIW OF PUBLIC WORI(S <br />AGENDA ITEM REVIEW REQUEST FORM <br />Timmer <br />Department DCI <br />BPW Date 8/28/18 Phone Extension 5841 <br />Legal Attorney Name Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.100 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check them Aplro date Iterri Type — Required for Afl Submi8sions <br />❑ Agreement M Contract ❑ Proposal ❑ Addendum <br />E] Professional Services <br />[] Bid Opening <br />F-1 Quote Opening <br />F-1 Change Order No., <br />❑ Ease/Encroach. <br />❑ Other: Amendment <br />El Resolution <br />❑ Bid Award <br />❑Quote Award <br />❑ C/O & PCA No. <br />El Traffic Control <br />0 Req, to Advertise <br />F1 Title Sheet <br />Company or Vendor Name Life Treatment Centers, Inc. <br />New Vendor F-1 Yes Z No F1 If Yes, Approved by Purchasing <br />MBEANBE Contractor F-1 MBE F] WBE <br />MBEA1VBE Contractor Requested Z No F] Yes Name of Company <br />Project Name Emergency❑Shelter Operations <br />Project Number 18-JC-03 <br />Funding Source Emergency Solutions Grant (ESG) <br />Account No. 212.1001,460.30w30 <br />Amount $,32;608 <br />Terms of Contract 1/01/18 — 12/31/18 <br />Purpose/Description Subsidize costs associated with operating emergency shelter for <br />homeless individuals <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc, <br />Amount of El Increase $ <br />El Decrease $ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: <br />SO <br />Dispersal After Approval <br />Copy <br />Original <br />M <br />F-1 Judy Love <br />F] <br />E l!i <br />11 <br />