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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date a tember 10__ww <br />—........p . 2019 <br />Department Community <br />Name Tim Corcoran Investment <br />BPW Date September 24, 2019 Phone Extension 7692 <br />................................ <br />............. .... ...... <br />Required Prior ITto Submittal to Board <br />Legal <br />X <br />Sandra Kennedy <br />e <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller <br />X <br />and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />X <br />w Check the Ap <br />ropriate Item Type Required for All Submissions <br />� reement <br />� <br />Contract sa �_ �µ <br />� Proposa.l... Addendum <br />_.�A .�. e������� ......... <br />X Services <br />..�._._ .._......� .......�_��_ <br />Amendment <br />Bid OpeningsI ...... <br />�� <br />_ ...._..........__. <br />�..... Re to Advertise w�.mm._.__ <br />w . q� ( Title Sheet <br />n <br />Quote O enin <br />�__ ...� <br />� <br />Quote Award <br />❑ <br />�..........__ <br />Ch Order No. <br />❑_......._....w <br />C/O &PCA No. <br />�] <br />PCA <br />�. <br />______ <br />Ease./Encroach. <br />�] <br />Traffic Control <br />Resolution <br />❑ <br />�..... <br />Other: <br />.M _...v_.._ <br />[� <br />Claim _._..... <br />Required Information <br />Company or Vendor Name <br />Strong Towns <br />New Vendor <br />X Yes X If Yes, Approved by Purchasing <br />No <br />MBE/WBE Contract <br />Contractor <br />� <br />MBEs _... ._..........._......... Y...i_ <br />WBE Completed E-Verify Form Attached ❑ es <br />❑ No <br />Project Name <br />Strong Towns Tour <br />Project Number <br />N/A <br />Funding Source <br />211-1001-460.31 06 <br />Account No, <br />N/A <br />Amount <br />$6000 <br />Terms of Contract_ <br />One-time fee <br />Purpose/Description <br />Partnering the Notre Dame and the Realtors Association to host ............. <br />Charles Marohn and the Strong Towns Book Tour for a one -day <br />event in South Bend to discuss strategies for making South Bend <br />a more resilient cityw <br />�.. �...._._.� �� <br />For Change Orders Only <br />Amount of ❑ Increase <br />❑ Decrease <br />$ <br />$w <br />Previous Amount <br />$ <br />Current Percent of Change <br />% <br />New Amount <br />_�.. mm. _.. <br />$ <br />Total Percent of Change: <br />.......... ...._...--- <br />Time Extension: <br />... __ _m....� _.. - ....... ...._.......... -.. <br />_......�w.... <br />ersal After <br />Copy <br />Original <br />......_� <br />...pis <br />............_Approval _... �....mm.... <br />Corcoran <br />_.. <br />.... <br />�.�... .......... <br />�. m __ <br />