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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/25/2019 <br />Name Lor Timmer Department DCI <br />Phone Extension....__ __... ...... 5841 ... ......_�� <br />019 <br />PW Date 10/08/2 <br />_ ----- <br />_ .. .._w w .� ...... .... . ..._ ... <br />o Submittal to Board c Prior t��.. �.- ,_ ..... �.. �.... <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney "q Attorney Name <br />Purchasing ® Michael Schmidt <br />....Check the : l)�ix'vriatc Ite.. _...�.�. <br />Sandra Kennedy <br />LJ Professional Services Agreement Z Contract <br />F Open Market Contract ❑I, Amendment/Addendum <br />E] Bid Opening El Bid Award <br />❑ Quote Opening Quote Award <br />El Proposal Opening enin C/O & PCA No. <br />❑ Chg. Order,' No. ❑ Traffic Control <br />.. Othermm.. <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 />l All Submissions <br />Proposal <br />L_J Special Purchase, QPA <br />El Req. to Advertise <br />Reject Bids/Quotes <br />(� PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />uth <br />_..So YeB�dif YYoes,��Ao rovedab�LL��Purcha ...,_.......�..... _..,......�...._....... ......... <br />Approved y sing <br />® No <br />❑ MBE Completed E-Verify Form Attached z Yes <br />❑ WBE ❑ No <br />Single -Family Home New Construction Activity <br />17-JC-58 <br />oninlunity Development Block Grant (CDB_ <br />212.1001.460.39.30 <br />$210,000.00 <br />1 /01 /2019 — 12/31/2021 <br />Provide a development subsidy for the construction of asingle-family hom, <br />f <br />for a lmod ... income homebur <br />ow .....�w„wwwwwwye <br />m� ......... _.� ._. <br />For C1r�e Orders Only <br />.... <br />Amount of El <br />Increase $ <br />m �_. <br />I❑ <br />Decrease �$......._ <br />Previous Amount <br />$ <br />...... —... ......� ......._ .�.._.—_.., <br />Increase <br />_... .. . �. <br />%..�,�..m. _.... �.... <br />Current Percent of Change: <br />g <br />Decrease <br />�a. A, ..�._..... . ........ <br />/o) <br />New Amount <br />$ <br />_A. � .. ....... ..�_.. �..._..... ....._.— <br />...._. .._ <br />Increase <br />..... _ ..... �.......... .- ...... <br />% <br />Total Percent of Change: <br />Decrease <br />..���. a _.....e... �.... N... —__ ....... u. <br />Time Extension Amount: <br />New Completion Date: <br />�... <br />........ �..,_ ... ...... <br />.... ...... - - - — _-- <br />