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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3-5-19 <br />Name . Brian <br />....Donoghue Department Innovation <br />BPW Date 3-12-19 Phone Extension 7652 <br />mimiiiiiiiiiiiiiiiiiiiillillillillillillilliillillilillillillillillillillilNOWT <br />m� <br />RequiredM Prior to Submittal to Board <br />Legal ® Attorney Name 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 <br />VJ Agreement <br />Professional Services <br />El Bid Opening <br />Quote Opening <br />Change Order No. _ <br />❑ Ease/Encroach. <br />0 Other: <br />�T+bp late Item Type — R ire for All Submissions <br />[❑� Contract D Proposal ❑➢ Addendum <br />❑] Resolution <br />E] Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />El Quote Award <br />El C/O & PCA No, ❑ PCA <br />Traffic Control <br />uired Information <br />Company or Vendor Name Bloomberg Philanthropies <br />New Vendor Yes E No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract 1 /1 /2019 — 12/31 /2021 _ <br />Purpose/Description GrantChallenge <br />agreement for Bloomberg Ma e <br />Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment,„ E-Verify, Iran, etc. <br />Amount of El Increase <br />Decrease <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: <br />Dispersal AfterApproval <br />Copy Original <br />® ❑ Denise Reidl <br />® ❑ ......__ ............. .............................��.................................. ......... <br />D aniel Parker <br />® ❑�' Brian Donoghue <br />