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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/3/2019 <br />Name LoryTimmer Department DCI <br />BPW Date 12/10/2019 <br />Phone Extension 5841 <br />uuiuiEiWuiuuu�wu z. r.�r mr�,�wwu�w�umw�w�u�u�u�u�u�w�w�w�w�w�w urvs w nmrt sx's sr�,..��.r iuumiWuuuumrl�,.�,�� 1-; <br />�v3�. _........ <br />........� <br />Re uired Prior to Submittal to <br />_ ..... _ .. Board _.............. ... �..w..,.. _.m.�. .... ............ <br />BPW Attorney <br />® Attorney Name Clara McDaniels <br />Dept. Attorney <br />Attorney Name Sandra Kennedy <br />Purchasing <br />® Michael Schmidt <br />Check.... �.� .......�...... _.. ...... <br />the.... � to 1'e Item `ype l t� uh' �.�ri t All Submissions <br />Professional Services Agreement <br />❑ Contract <br />Proposal <br />[❑ <br />Open Market Contract <br />® Amendment/Addendum O' <br />Special Purchase, QPA <br />EJ Bid Opening <br />Bid Award ❑ <br />Req. to Advertise ❑ Title Sheei <br />Quote Opening <br />0 <br />Quote Award E] <br />Reject Bids/Quotes <br />n <br />Proposal Opening <br />❑j <br />C/O & PCA No. ❑ PCA <br />Chg. Order, No. <br />Traffic Control <br />❑ Resolution <br />Other: <br />❑ Ease./Encroach <br />gNuired Information <br />Company or Vendor Name <br />Near Northwest_nc. <br />�❑] <br />YesIf Yes, Approved bye Purchasing <br />New Vendor <br />® No <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached No <br />Project Name <br />Acquisition / Rehab Activit <br />Project Number <br />17-JC-23 <br />Funding Source <br />. <br />Community Development Block Grant (CDBG) <br />. _ ....- _.m------------------ m ..... <br />Account No. <br />212.1001.460.39.30 <br />Amount <br />No change in c ontract amount <br />Terms of Contract <br />1/01/2019 — 12/31/2021 <br />Purpose/Description <br />Extend .................... �. ��months- g e _ . r_31 2020. <br />contract timeframe by 12 mon�lt� throu h D cembeITITIT_ � ....... <br />For Chajip Orders Only <br />�...._ <br />Amount of <br />increase <br />$ <br />Decrease $ <br />Previous Amount <br />$ <br />Increase /o <br />Current Percent of Change' <br />Decrease %) <br />New Amount <br />$ <br />Increase % <br />Total Percent of Change: <br />Decrease %) <br />Time Extension Amount: <br />New Comnletion Date: <br />