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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />12/9/19 <br />Michael E. Sniadecki <br />Department Innovation & Tech <br />BPW Date 12/19/19 Phone Extension 6004 <br />likWlllllllll�l�'�lAi u � ....mvs JVi NtlO� WIY .. ya'£�r F���'w�i�6M,ku/{xN/M�N��ihmIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�;W�gFiY q,9A4PAp,IpU&p/➢UE"JION!!,'I'I�N'�'ll NINi�YN�M�kvYvY1�10tlIWUJWN;"ifY ���+����A6GibSJui, <br />�.,.,...., .,...... ........ ...,.o...,..........�,.,,.�.a...,.. �.....�............................—...,..�,..,. <br />required Prior to Submittal to Board <br />Legal ® Attorney Name Sandra Kennedy <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the Appropriate Item Type <br />Agreement <br />® Professional Services <br />Bid Opening <br />El Quote Opening <br />[] Change Order No. <br />El Ease/Encroach. <br />E Other: <br />LJ Contract <br />❑ Resolution <br />❑' Bid Award <br />Quote Award <br />[� C/O & PCA No. <br />❑ Traffic Control <br />for All Submissions <br />j Proposal 0 Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />uired Information <br />Company or Vendor Name ChoiceLiht (formerly Metronet Zi <br />❑ PCA <br />New Vendor ❑ Yes Z No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />City of South Bend -Metronet Buildout Phase 3 <br />Project Name (Choice Light/Metronet Portion) <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ <br />Previous Amount <br />n/a <br />IT Professional Svc <br />279-067..........._ <br />2-415-31-06 _ <br />A one-time cost of $259,312, <br />Statement of Work <br />Add six COSB locations to the Metronet during phase 3 of this <br />project.. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination„ Non -Debarment, E-Verify; Iran, etc. <br />Required For Change Orders Only <br />Increase $ <br />Decrease <br />.......... <br />Current Percent of Change: % <br />New Amount $ <br />