Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5-6-19 <br />Name Brian Donoghue Department Innovation <br />BPW Date 5-14-19 Phone Extension 7652 <br />Required 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 />Agreement <br />�] Professional Services <br />Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />El Ease/Encroach. <br />❑ Other: <br />aropriate Item Type <br />F] Contract <br />[J Resolution <br />❑ Bid Award <br />❑ Quote Award <br />C/O & PCA No. _ <br />❑ Traffic Control <br />Required Information <br />Company or Vendor Name University of Notr <br />New Vendor ❑ Yes ® No [ <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount......... .........__................... <br />Terms of Contract 5/20/2019_.........................— 8/31 /2019 <br />Purpose/Description Placement agreement for rant -funded intern via Lab for Economic <br />Opportunity at University of Notre Dame <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For'Change Orders Only <br />Amount of Increase $ _.. <br />❑ $ ......... ................. ..... _............. .. �__..._.... <br />Decrease. <br />.. <br />Previous Amount $ <br />...... ................ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />. ........ ..... <br />Dispersal After Approval <br />Copy Original <br />® ❑ Denise Reidl <br />® ❑ Sonja Karnovsky ���..�.... ..�..._..�. ..........................-....���_�_ <br />® ❑' Brian Donoghue_��.._.........................a. ...._..._____ .�........._ <br />for All Submissions <br />Proposal El Addendum <br />Req. to Advertise ❑ Title Sheet <br />❑ PCA <br />If Yes, Approved by Purchasing <br />Name of Company <br />