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130ARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE QUEST FORM <br />8/30/18 <br />WINIKEEM <br />Department DCI <br />BPW Date 9/11/18 Phone Extension 5841 <br />Required Prior to 'Submittal to Board <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 />0 I IS <br />Agreement <br />F-1 Professional Services <br />[] Bid Opening <br />El Quote Opening <br />F-1 Change Order No. <br />F] Ease/Encroach. <br />R Other: Amendment <br />F-1 Resolution <br />El Bid Award <br />Quote Award <br />C/O & PCA No. <br />Traffic Control <br />E] Req. to Advertise <br />MIMI' <br />Company or Vendor Name The Center for the Homeless, Inc. <br />New Vendor E] Yes E No 0 If Yes, Approved by Purchasing <br />MBEANBE Contractor [:] MBE F-1 WBE <br />MBENVBE Contractor Requested 0 No E] Yes Name ofCompany <br />_ <br />Project Name Coordinated Entry Program <br />Project Number 18-JC-80 <br />Funding Source -Community Development Block Grant (CDBG) <br />Account No. 212.10101 A60.39,30 <br />Amount $50,1000 <br />Terms of Contract <br />Purpose/Description <br />Amount of F] <br />El <br />1 /01 /18 — 8/31/19 <br />FWATSTINTIT, Im 17, <br />El Title Sheet <br />S - ubsiclize staff costs associated with connecting homeless persons <br />to housing and support services <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, Non- Discri rn i nation, Non -Debarment, E-Verifv, Iran, etc. <br />Increase $ <br />Decrease $ <br />Previo6s Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />M <br />R Judy Love <br />F-1 <br />R <br />F] <br />El <br />