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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/21/2019 <br />Name I:.do � "�� ,unmet".._� �.... DCI <br />_�. ... Department ..—..._- . <br />BPW Date 12/10/2019 Phone Extension 5841 <br />wmwuwww�wuwuu�wY.uww rrm�mnr�r rsommwwuimmuiowwWimme .a �r�azur%w mra iur^�rmm :�r, wiHiHiHUHUHuuuuwuwuwuwuwuwu ..�u.� uomu�arm�uuuuuuuuuuuuuuuuumwrrtr�rr, arex+mv�nr .,. �oHIR <br />_......., .. .. ._._.___... _�.......W—. <br />Rgr�:ed Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney y p y Attorney Name Sandra Kennedy <br />Purchasing ® Michael Schmidt.�.....................__e. _�.._. ... <br />Check the Appropriate Item <br />Ll Professional Services Agreement ❑ Contract <br />F-1 Open Market Contract <br />® Amendment/Addendum <br />n Bid Opening <br />Bid Award <br />Quote Opening <br />n Quote Award <br />Proposal Opening <br />E] C/O & PCA No. <br />n Chg. Order, No. <br />E] Traffic Control <br />Other: <br />Rcc����_�r Information <br />r All Submission <br />F-] Proposal <br />Special Purchase, QPA <br />L Req. to Advertise <br />FI Reject Bids/Quotes <br />[] PCA <br />❑I Resolution <br />[]' Ease./Encroach <br />❑ Title Sheei <br />Company or Vendor Name <br />Northwest Neigllb <br />Near orl1990, Inc.m <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />Lead Based Paint Hazards Outreach Program ...... <br />e„ <br />Project Number <br />18-JC-39 <br />FundingSource <br />Commu y Grant (CDBG) <br />mt Development Block ,,....�:_ ... <br />Account No. <br />___ .......... <br />212.1001.460.39.30 <br />Amount <br />No change in contract amount <br />Terms of Contract <br />5/01/2019 - 12/31/2021 <br />Purpose/Description <br />Ex and the nu_-catcc i �� tuber of cost _ 3es that are eli able for CDBG <br />reimbursement <br />For 1;�� O _........_ ., . <br />��._�an Orders Oily...., <br />Amount of <br />crease $ y .. �...�... ,. <br />�]Decrease <br />($ ) <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />( % <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />