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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />7/18/2019 <br />Timmer <br />Department DCI <br />BPW Date 8/13/2019 Phone Extension 5841 <br />�1111 ME .....ur W;m awv�s sss :c �k�......��oo nm�a�vow�uu�a�u�u�uuw�uW�uWew�uurvun�+rrm;! <br />.... ...�.�...�,�... ... _ ... <br />Required Prior to Submittal to Board <br />W Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Z Attorney Name Sandra Kenned <br />Purchasing Z Michael Schmidt <br />Check the Ap.�te Item Type <br />r <br />Professional Services Agreement Contract <br />Open Market Contract ❑ Amendment/Addendum <br />F] <br />Bid Opening ❑ Bid Award <br />❑ <br />Quote Opening ❑ Quote Award <br />❑ <br />Proposal Opening ❑ C/O & PCA No.. <br />❑ <br />Chg. Order, No. ❑ Traffic Control <br />❑ Other: <br />Information <br />All Submissions <br />H Proposal <br />❑I, Special Purchase, QPA <br />El Req. to Advertise <br />[� Reject Bids/Quotes <br />PCA <br />j Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />Company or Vendor Name <br />p Y <br />t n tme <br />De a tt11CIlt of Con mLinm Investment <br />_.__.�I�.�� <br />Yes[] If Yes, Approved y Purchasing�---�.. . <br />ved b <br />New Vendor <br />® No <br />MBE/WBE Contractor <br />❑❑ MBE Completed E-Verify Form Attached ®❑ Nos <br />Project Name <br />._.Historic eview of Federally -Funded Projects....R...........................a�.��. <br />Project Number <br />19-JC-06 <br />Funding Source <br />Community DevelopmeLit „Block Grant <br />Account No. <br />212.1001.460.39.30 <br />Amount <br />.�..... �, ..... ........ <br />$5,000.00 <br />Terms of Contract <br />_ <br />_....1 /01 /2019 —12/31 /2019 <br />Purpose/Description <br />. federallv- funded proiects� <br />Subsidize staff HPC costs for z'�,viewm <br />.................. <br />For ch n mmOrders Ool <br />Amount of <br />Increase $ <br />El <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />_ % <br />Decrease <br />°ro <br />Increase <br />% <br />Decrease <br />( % <br />