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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />11/05/19 <br />WNW <br />Department DCI <br />BPW Date 11/12/19 Phone Extension 6209 <br />1i:%/�',YYrtFhrYh2M MN MWu90U' III�IN M�XNI4'dwHIWA.'JPmIC aeP,m»z.,v: Rum flAlrMl�fl�M YJA'. Npl�'N PoiJ@ia'1�.1 + +/i/i/iw�vivH,� <br />Required Prior to Submittal ........_ �m.....� __..�.� _._.._.....�y�. <br />m mittal to Board <br />BPW Attorney ® Attorney Name Clara Daniels <br />Dept. Attorney ® Attorney Name Sandra Kenned <br />Purchasing ® Michael Schmidt � <br />Check the Appropriate Item Type - 1 <br />El Professional Services Agreement Z Contract <br />El Open Market Contract El Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />Fj Quote Opening ❑ Quote Award <br />Proposal Opening E.] C/O & PCA No. <br />❑ Chg. Order, No. ❑ Traffic Control <br />�' Other: <br />Information <br />Ammmmmm Su bmissions <br />L J Proposal <br />❑ Special Purchase, QPA <br />EJ Req. to Advertise <br />E] Reject Bids/Quotes <br />PCA <br />Resolution <br />❑ Ease./Encroach <br />❑ Title Sheel <br />Company or Vendor Name <br />EnteipriseAssociation� of South Bend, Inc. <br />New Vendor <br />If Yes, Aww_ <br />0 ❑ ppcowed by Purchasing <br />® No <br />MBE/WBE Contractor <br />❑ ❑ <br />MBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />Staff Services <br />Project Number <br />,.. �.. m.............rw <br />N_ �... � .. ........ .... ...�.....�r_ <br />/A <br />Funding Source <br />UEA Funds paid to City <br />Account No. <br />N/A <br />Amount <br />$40,00... <br />0.00 <br />Terms of Contract <br />I/l/2020-12/3� .... .. �� <br />/2020 <br />Purpose/Description <br />_Payment to City for DCI staff work related to U programs <br />For Chan e Orders 0111 <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 />1Iq <br />Increase <br />% <br />Decrease. <br />% <br />Increase <br />Decrease <br />( % <br />