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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/10/2019 <br />Name Dan Buuckentnever Department DCI <br />BPW Date 7/23/2019 Phone Extension 5328 <br />iW.:'.G:.'.1fi:v.4"fYFW�s'¢ash'�u�,'�IfI�NIF�NININININIFJINi�W" JfR14441mm1�4lNllXlm iiii IiViVI!Wlk'VNl%04Ytt��m'4M,�m :i v;:w.;.__teR mm-m_nod'IMW�YfAZbW�B:SRC'MaiY�Xi�ilPlllllllllllllllllllllllllllllllllll°k.WWdM,tNd3YlttJllk{MIK�MNI%DN,86'.mfiJ nuv�w�msm '.✓3kR'.,W r4i,.�.e9.N%:fRM➢fJId <br />l ec wired Prior to Submittal to Board <br />....� ...... ..._... .......mwm ���...... _._ <br />BPW Attorney ❑ Attorney Name Sandra Kennedy <br />Dept. Attorney ❑ Attorney Naive <br />Purchasing <br />Professional Services A Agreement ®Contract <br />E] Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening E <br />I Bid Award <br />❑ Quote Opening Ej Quote Award <br />❑ Proposal Opening C/O & PCA No. <br />F Chg. Order, No. F] Traffic Control <br />Other: <br />Required Informati <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 />Proposal <br />E, Special Purchase, QPA <br />El Req. to Advertise <br />[! Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Purdue MEP <br />......... .......................... <br />❑ Yes❑..I......................... �...�.�.�.................................�.�.......m.... .._._. <br />f YeApproved d by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />Pathways On Demand Proeram <br />EDIT <br />404-1001-460-39.3 0 <br />$21,500 <br />Training programs to train necessary skills to under skilled workers to meet <br />labor needs in the community. <br />For �ha� c Orders Onl <br />Amount of Increase $ <br />Decrease <br />Previous Amount $ <br />Current Percent of Change. - <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase % <br />Decrease ( % <br />Increase % <br />Decrease % <br />