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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 7, 2019 <br />Name P................ Meyer................---..�....w.............. ........�.................. <br />Pam Department DCI <br />BPW Date January 22, 2019 Phone Extension 5845 <br />i����,wrn�a�wu�umrmm�mwNwummwammmiemm!�mwirrrcam�miiiu�ware�usazr�✓✓�rau�wmemewiv� m�wezwwR�wuwur,wuir�rvw�m��u�wwwwwwwwwwwww�w�m�r. � oiwuwarumimwumwwweuwm�.wwuuw.w.�wua�uwwiww.ww�o„m!mwu,�e�w.wwwiuvv��uurcmw�a�w <br />ReSubmittal to Board <br />uired Prior to <br />e........_....�....._ ...... .....�.. c... <br />Legal Attorney Name Sandra Kennedy <br />Controller Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing M <br />Check the <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />E] Change Order No. _ <br />❑] Ease/Encroach. <br />0Other: <br />dre riafe Item T e / e ikq� for All Submissions <br />❑ .......... �......._. � P �A... —d e,..._ ............ <br />Contract Pro osal ddendum <br />El Resolution <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑I Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control <br />Required Information <br />Company or Vendor Name Neil Mihalich <br />New Vendor ® Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />Project Name Lead Protection Program Manager for IHCDA Lead Funding_ <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />CDBG-Disaster Re rvovery and Lead Hazard Reduction Funding through <br />A IHCD.. 6—". )1U <br />$ 58,581.00 <br />1 /22/ 19-12/31 / 19 <br />. ..._............. <br />Services agreement for manage-...m....... <br />ment of IHCDA lead grant <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non-Discrimination,--Non-Debarment, E-Verify, Iran, etc. <br />wired For Change Orders On <br />Amount of El Increase $ <br />Decrease $ <br />Previous Amount $ <br />