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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 17.2019 <br />Department <br />Innovation & <br />Name SoniamKarnovsky Technology <br />BPW Date June 25, 2019 Phone Extension 9098 <br />Reg uiaed Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ® Attorney Name <br />Purchasing <br />Check the ADorooriate Item 'Tvne — <br />LJ Professional Services Agreement LJ Contract <br />Sandra Kennedy <br />0 Open Market Contract <br />® Amendment/Addendum <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Quote Opening <br />E] Quote Award <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />F1 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 />Information <br />d or All Submissions <br />❑ Proposal <br />❑ Special Purchase, QPA <br />n Req. to Advertise ❑ Title Sheet <br />E Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />❑ Ease./Encroach <br />Five/ Four Advisors <br />__.._ Yes If Yes, Approved b Pu ........ ..... ........._.... ..............w. <br />❑ ❑ ................PP Y rchasing <br />El No <br />MBE Completed E-Verify Form Attached El Yes <br />WBE ❑ No <br />CDFI Friendly City <br />..................... . .......... <br />19JO03 <br />_...__.... .. <br />.............. <br />..._.. <br />Redevelopment General Fund <br />433.1050.460.39.30 <br />$100,000 <br />1/l/2011 ................ <br />9 — 2/31 /2019 <br />Update to CDFI Friendly Contract with Phase Two Scope of Work to explore <br />capacity and ability to implement CDFI Friendly City Model in South Bend <br />For Change Orders Ohl <br />Amount of ❑ Increase $ <br />❑ Decrease ($ )—......... WW <br />Previous Amount <br />$ <br />_.................... <br />........ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />( % <br />New Amount <br />$ <br />....M <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />w% <br />New Completion Date: <br />