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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/10/2019 <br />Name Dan Btickennie.. er Department DCI <br />BPW Date 7/ 3/ 019 Phone Extension 5328 <br />... .: `..........m s . ............... _ ... <br />.,..�m ............ _ and 1�,t utttl Prior to Submittal to _ ..... .. .. .. .. <br />BPW Attorney Attorney Name Sandra Kennedy <br />Dept. Attorney <br />Purchasing <br />E Attorney Name <br />01 <br />Professional Services Agreement N Contract <br />Open Market Contract El Amendment/Addendum <br />Bid Opening E] Bid Award <br />❑ Quote Opening E] Quote Award <br />E] Proposal Opening ❑ C/O & PCA No. <br />F Chg. Order, No. Traffic Control <br />Other: <br />ec aired Informati <br />Company or Vendor Naive <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 />Special Purchase, QPA <br />Req. to Advertise ❑ Title Sheet <br />E] Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />Ease./Encroach <br />Michiana SHRM_ <br />....�..� ......... _........ <br />......................... <br />----------------- <br />.........................�._...... <br />Yes❑ If Yes,A <br />❑ pproved 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-.�1..0�0.�1..-46.0. <br />_ -39.30 <br />Training programs to train necessary skills to under skilled workers to meet <br />labor needs in the community. <br />For Change Orders <br />_...mly <br />Amount of Increase .... _ �.........m..._...__ �.�._ �...�_u <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 />k <br />Increase <br />% <br />Decrease <br />( % <br />Increase% <br />,_...�.�.�.�.�.�.�.�.�.�.�.�.�% <br />Decrease <br />