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Date <br />Name <br />BPW Date <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />1012118 <br />Suzanna Fritzbera <br />1019118 <br />Department Mayor's Office <br />Phone Extension 5818 <br />L Agreement <br />L Contract <br />U Proposal L Addendum <br />® Professional Services <br />❑ Amendment <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ CIO & PCA No. <br />❑ PCA <br />❑ <br />Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />M <br />Other: <br />n Claim <br />Company or Vendor Name Michiana Health Information Network (MHIN) <br />New Vendor ❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />MBEIWBE Contractor ❑ MBE Completed E-Verify F�orm.Attached El Yes <br />❑ WBE ❑ No <br />Project Name Lead Screening Identification and Alerting Project <br />Project Number 18JO14 <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />EDIT <br />408-1001-460-39.30 <br />$16,950 <br />6-vear <br />Professional services contract between COSB and MHIN for data <br />analysis of property records, electronic medical records, and <br />environmental health data related to child lead poisoning in the <br />City of South Bend, and provider alerts regarding the same. <br />Amount of ❑ Increase <br />❑ Decrease <br />