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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />8/15/2019.................................._..............—.�......... <br />Timmer <br />Department DCI <br />BPW Date 8/27/2019 Phone Extension 5841 <br />", mffi&WIW.YWWIWIuw. ;',M+2mid v➢S.�T.!✓dF,5! k✓,3'fMMryFfgpyflyiPofNYArye�¢u[�+ yllN , ouuMlYwrl("L�"Jfflfg ;90 0R GpiMFulRM �uuuuuuuuuuuuuuuumwulWWNP� viu dl9pK'�,q&u'�6W <br />.. _.....,,,m„�...—....�,�, ww...A � � , ..,. �, �, _ ,.,. .............. <br />� �..._ ........ ._,m.............. <br />�._ �. � : � �.:�:. N..m,,,,, �� t al tOBOard ��rc Prior to Submia..._.... �.� �............. .�...� ._.. <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Z Attorney Name <br />Purchasing ® Michael Schmidt <br />Check the Appropriate Item Tyr <br />LJ Professional Services Agreement Z Contract <br />Sandra Kennedy <br />❑] Open Market Contract ❑ <br />Amendment/Addendum <br />E] Bid Opening El <br />Bid Award <br />❑ Quote Opening <br />Quote Award <br />F'' Proposal Opening <br />C/O & PCA No. <br />❑ Chg. Order, No. ❑ <br />Traffic Control <br />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 />s or All Submissions <br />❑j Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />Q Reject Bids/Quotes <br />PCA <br />❑j Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />CA North Central Indiana Inc. <br />Yes❑ If Yes, Approved by.,Purchasing <br />® No <br />�❑ MBE Completed E-Verify Form Attached ® Yes <br />WBE ❑ No <br />Emency Shelter Operations & Rapid Rehousing Activities <br />19-JE-04 <br />mer enc Solutions Grant (ESG) <br />212.1001.460.39.30 <br />$58,069.00 <br />1 /01/2019...._...2.................................... <br />/26/2021 <br />Subsidize the cost of o eratin a homeless shelter; provide rentalIT-assistance <br />for per �a�aegt h.Q-4 <br />. _tinge Orders O� :. <br />m,- ... .....__..w_ .. ,,� _ .. ❑�,:� ........ For C ���.... <br />Amount of Increase $ <br />...., m <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 />%_ <br />Decrease <br />( % <br />Increase <br />% <br />......................�....,...,.......ww <br />Decrease�� <br />