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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/26/2019 <br />Name Lary Timmer Department DCI <br />�.. <br />BPW Date 8/13/2019 Phone Extension 5841 <br />MJI1WWu' l u i cW/PAW �'1Fv�?Y.M9pG'F1'➢A"!"�WW'�dplalRni. �4'6'�BCd6�iYY�MMgf/WM�°4�': ttr v '�'AXAM'!.k'IJA�.+:umM�1WIYMM ;�,��F,p <br />.� Rcz�i�tmPriorto Submittal to Board B <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Sandra Kennedy <br />Purchasing ® Michael Schmidt...........��. ....v�_......,_ ....� <br />the Appronr ate Item "I'voe — <br />_ � Contra ._..._ _... <br />Professional Services Agreement act <br />❑ Open Market Contract ❑ Amendment/Addendum <br />Bid Opening Bid Award <br />❑ Quote Opening Quote Award <br />E] Proposal Opening C/O & PCA No. <br />❑ Chg. Order, No. ElTraffic Control <br />El 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 />All Submissions <br />L Proposal <br />1-1 Special Purchase, QPA <br />E] Req. to Advertise <br />0 Reject Bids/Quotes <br />El PCA <br />El Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />South Bend -nd fcri, j gc Foundation <br />Soe❑ <br />Yes, Approved by Purchasing <br />® No <br />MBE Completed E-Verify Form Attached ® Yes <br />�] WBE ❑ No <br />CDBG Activitv Delivery <br />... .... <br />_...... For n CI°r,a� grders Oni <br />Amount of El <br />Increase $ <br />L� <br />Decrease $ <br />Previous Amount <br />$ <br />Increase <br />/o <br />Current Percent of Change: <br />Decrease <br />/o) <br />NewAmount <br />$ .. �.�........... <br />Increase <br />_.�,................. m.�,.............................. _ ._..... �... <br />% <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />