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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date10/23/19�_................._._......................_._w........ m..... <br />Name Rahman Johnson Department A&F <br />BPW Date 11/12/19 Phone Extension 5921 <br />�mmnmmnmmmmmmmnmuuumrvo!wiro�uwuum!mnriw;menuimr,�a ewn.+m, wrvud��nwuwn�asr,�meHrmu!!m�wwwmmmmwmmm.�mmmmwwwwwwuW.w�wrcw�wevasaa�a�wsuso.,,,,�rr,.„„011wwwmwimuwwur��usmmamimuuuuuuuuumuiw�uuuuuuuuuuuuuuuuuuuuuuum� <br />�....... w.._ .,�..,,.�......, ,.�..m.m.,�_.�—.. _�— ---------- <br />.._............. .,. ...... <br />�q ed Prior to Submittal to Board <br />BPW Attorney I] Attorney Name Clara Daniels <br />Dept. Attorney E] Attorney Name Sandra Kennedy <br />Purchasing El Michael Schmidt <br />Check the Appr priate Item "1'yp ,._. <br />[l Professional Services Agreement ❑ Contract <br />Open Market Contract <br />[:]' Amendment/Addendum <br />❑j <br />Bid Opening <br />F-� Bid Award <br />E <br />Quote Opening <br />❑ Quote Award <br />Proposal Opening <br />❑ C/O & PCA No. <br />Chg. Order, No. <br />❑ Traffic Control <br />Other: Non -Sufficient funds <br />ired Information <br />All Submissions <br />❑ Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />(� Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />Company or Vendor Name City of South Bend — Admm and Finance <br />New Vendor <br />] YesLJ If Yes, Approved by Purchasing <br />® No <br />MBE <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ <br />Project Name <br />N/A <br />Project Number <br />----.........�.............................................�....................................._............._._._......�� <br />N/ A <br />FundingSource <br />.....N/A........�................ _�.,.�.�.�...............................................................�.....�.�.�.�........ <br />Account No. <br />Various <br />Amount <br />$9,,13 9.76 <br />Termsof Contract <br />N/A.............................................�..........�.�......www_.eeeee...................................................................... <br />Purpose/Description <br />........._ .. m <br />Write -off -Insufficient funds from 201IT3-2016 <br />❑ Title Sheel <br />Yes <br />No <br />.. <br />For Cl arrgc Orders Only <br />Amount of Increase $ <br />❑ Decrease �$ <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease % <br />Increase % <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />New Completion Date: <br />