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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 18, 2018 <br />Name Pam Meyer Department DCI <br />BPW Date December 20, 2018 Phone Extension 5845 <br />Warn w�rcrmommwmm��wi!�rnn�i�a>� �� ..�;.,mmuuumimiomi ��ti � m�oioioi��om�im�imimm�umww�ewiyiyiiuiuiuiuiuwwiuuuiumiuiuiv �u�muumHUHuuumHUHUHUHmwuuiuwiuiuwiuiuiuiuiuiuwiuiuiuiu � uam�nrurauruu�n�vuuuuuu <br />.....�..�...... Required Prior <br />�..�..�� ..._.._u.� <br />to Submittal to Board <br />Legal ® Attorney Name Sandra Kennedy <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the A p r ate Item Type Req t ire for All Submissions <br />Z Agreement LJ Contract F-1 Proposal F-1 Addendum <br />0 Professional Services E:1 Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />El Quote Opening ❑ Quote Award <br />Change Order No. ❑ C/O & PCA No. ❑ PCA <br />Ease/Encroach. ❑ Traffic Control <br />Other: <br />�e _yired Information <br />Company or Vendor Name Goodwill Industries of Michiana, Inc. <br />New Vendor <br />0 Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />[:] MBE ❑ WBE <br />Project Name <br />Brides ERN-Em_Dloyer Resourc imgator <br />_..e Nav <br />Project Number <br />.�....COIT.....................................u...w <br />FundingSource <br />�.�.....................................................�.�.�......... .........._ <br />Account No. <br />� 404.1001.460.31.06���.......�.����..._��.��..� ..... � ..... �. <br />Amount <br />�..............................................................................................�_............................__............�..�. <br />$ 17,916.00 <br />Terms of Contract <br />1/1/19-12/31/��� _.....�� �,m. ............w...�. <br />2019 <br />Purpose/Description <br />Revises contracting g anziation due to Bridges or JJmerger with G ... <br />oodwi11 and <br />extends agreement through 2019 for balance of funds <br />® Required Contractor's Certification Form Attached (Non- <br />Non -Debarment, argent„ r� Iran etc. <br />_.....�...... .... ........ <br />_..._.,�� Required For Change Orders Ong .� <br />a._ mm..... <br />Amount of ❑ <br />❑ <br />Increase <br />Decrease $ <br />Previous Amount <br />_....�. ..� ��� _A..... _ .................... . <br />Current Percent of Change: % <br />New Amount <br />$ <br />