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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date11/05/19...................................wwww...,...,, ,..... ,., �m,...._��................. <br />Name Pam Mir__..... _......... Department DCI <br />BPWDate 11/12/19 Phone Extension 6209iiiiiiiiiiiiiiiiiiiiiillillillilluilmI <br />---.... ...... _ .... _....... __ _w <br />;ew�t l Prior to Submittal to Board <br />BPW Attorney . �..� ....._. ��. :::::.._........_...._ ...._� _.� ...............w .�:.IT <br />y Attorney Name Clara Daniels <br />Dept. Attorney Attorney Name Sandra Kennedy <br />Purchasing ® Michael Schmidt <br />Check the � t,� )!J Item 1,y) Ilir(' <br />F] Professional Services Agreement [:] Contract <br />E] Open Market Contract ® Amendment/Addendum <br />Bid Opening R Bid Award <br />E] Quote Opening ❑ Quote Award <br />Proposal Opening ❑ C/O & PCA No,. <br />Chg. Order, No. ❑ Traffic Control <br />Other <br />wmmm Required Information <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />EDIT <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />All Submissions <br />LJ Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />PCA <br />E] Resolution <br />❑� Ease./Encroach <br />❑ Title Sheel <br />,Center for the Homelessm� <br />❑ <br />Yes If Yes A ro.,,.�,n............................�.m.,..�..,................................._...,,,,,...,., ❑ pp ved by Purchasi g <br />® No <br />❑ MBE Completed E-Verify Form Attached NoEl <br />❑ <br />WBE <br />Permanent Supportive Hous gin (PSH) Program <br />EDIT _ <br />404.0401.415.31.06 <br />Additional $100,000.00 for total of $200,000 _. <br />�._. <br />I1/l/18-12/31/2021 <br />Provide rent and utility support for those moving into PS H <br />- For C'ha soil, <br />Amount of ❑ Increase $ <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 />Decrease ( % <br />Increase % <br />Decrease ,... �......................�..��. <br />