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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUESTFORM, <br />8/30/18 <br />Lory Timmer <br />Department DCI <br />BPW Date 91/11/18 Phone Extension, 5841 <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 />Purchasing M <br />Agreement <br />F-1 Professional Services <br />[J Bid Opening <br />[J Quote Opening <br />F-1 Change Order No. <br />[:] Ease/Encroach. <br />F-1 Other: Amendment <br />Contract <br />F-1 Resolution <br />[J Bid Award <br />El Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Z= <br />[:1 Req. to Advertise <br />Addendum <br />El Title Sheet <br />Company or Vendor Name YWCA North Central Indiana Inc. <br />New Vendor El Yes M No 0 If Yes, Approved by Purchasing <br />MBE/VVBE Contractor F-1 MBE F1 WBE <br />MBE/WBE Contractor Requested M No, n Yes Name ofCompany <br />_ <br />Project Name Emergency Shelter Operations & Rapid_Rehousing Activities <br />Project Number 18-JE-04 <br />Funding Source, Emergency Solutions Grant (ESG) <br />Account No,. 212.1001.460.39.30 <br />Amount $47,000 <br />Terms of Contract 1/01/18 — 3/11/20 <br />Purpose/Description Subsidize costs associated with operating an emer enc shelter for <br />homeless individuals provide rental assistance, for homeless clients <br />M 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 />Copy <br />Original <br />z <br />F] <br />1-1 <br />El <br />El <br />El <br />Judv Love <br />