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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />11/7/18 <br />Jitin Kain <br />Department pW <br />BPW Date 11/13/18 Phone Extension 5835 <br />;arm�ww�'�'��w�w�u�,u'uuum" �ma�;w, e�rvrm�r�W�ru�uw!��u!��u!��u!�uuw!wuwuwww�uwwiu�uemmm�iw� uumurrrmm�miratati a �wim�rvimimrvrmmuimuwiuim ma�anmuuuuuuuuuuuuumti <br />Required wPrior to Submittal to Board <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing 0 <br />--the <br />Ch_....e....Wckthe w..... A <br />DA Agreement <br />El Professional Services <br />E] Bid Opening <br />❑]I Quote Opening <br />n Chg Order No. <br />]� Ease./Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />El <br />erepriate Item Type - <br />( Contract <br />❑ Amendment <br />El Bid Award <br />El Quote Award <br />❑C/O&PCANo. <br />_ <br />El Traffic Control <br />d for All Submissions <br />Proposal <br />El Req. to Advertise <br />El PCA <br />Resolution <br />F-1 Claim <br />Addendum <br />❑ Title Sheet <br />R e uired InformationNeutro_ .._... w _..... <br />�] -Yes Holdings <br />�.._l . <br />If Yes, Approved by <br />Pu rchasing <br />® No <br />❑ WBE Completed E-Verify Form Attached Nos <br />First Amendment to Bike Sharinq Service Agreement <br />N <br />Amendment to Bike Sharing agreement with Neutron Haldin s <br />DBA- Lime to commence an e-Scooter ilot within a defined <br />___geography in South Bend. <br />..�.. <br />For ChangeOrdersOnly <br />Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Time Extension: ^m.................. <br />Copy Original <br />❑ ® Linda Martin <br />® 0 Jitin Kain <br />El <br />Dispersal After Approval <br />