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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/16/2019 _.............. - w <br />Name Lory Timmer Department DCI <br />BPW Date 12/19/2019 Phone Extension 5841 <br />cc �ii ed Prior to Submittal toITBoard <br />..... ........ _. _ ...::........ ._._...:_.. .... <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Z Attorney Name Sandra Kennedy <br />Purchasing Z Michael Schmidt <br />......... . .. ....... Professional Services Agreement Z Contract <br />[� Open Market Contract ❑ Amendment/Addendum <br />Bid Opening ❑ Bid Award <br />Quote Opening ❑ Quote Award <br />❑ Proposal Opening ❑ C/O & PCA No. <br />EJ Chg. Order, No. Traffic Control <br />Other: <br />[l Proposal . <br />E] Special Purchase, QPA <br />❑ Req. to Advertise <br />E] Reject Bids/Quotes <br />F] PCA <br />❑ Resolution <br />❑ Ease./Encroach <br />❑ Title Sheel <br />Company or Vendor Name <br />Our Lady of the Road Inc. �............. ,,.,.,� � ._. ........ ...�...._ <br />If Yes, A ed by Purchasing <br />Approved <br />New Vendor <br />Nos <br />El <br />MBE/WBE Contractor- <br />Completed <br />WBE Completed E-Verify Form Attached <br />Project Name <br />Operations <br />Relief Center O era ............... <br />Project Number <br />19-JO-56 <br />Funding Source <br />..P..........................ion..� �....... .�......................... <br />DCI Admin / Other ProfessionServices <br />Account No. <br />211-1001-460.31-06 <br />Amount <br />$21,094 <br />Terms of Contract <br />_� - �.......-�..........,,....�..�..�......__...... ........�........................._� _-..................�......... <br />2/01/19 - 1/31/20 <br />Purpose/Description <br />Subsidize � �l"o ���Ltjgg w� nnin , coolin g center at 744 S. Main Street <br />._.. . c cost <br />South Bend <br />..... W <br />For Change Orders Only <br />Amount of <br />Increase $ <br />❑] <br />Decrease$mmmIT ) <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: <br />� o........................................ .......... ......._....�.�.�...............----- ................ <br />Decrease <br />New Amount <br />.................�.�.�.�.�.�.�.�0.'.�� _......._........__.......................��.�. <br />$ <br />Increase......_......_.. <br />Total Percent of Change: <br />.--------- mwmwmw----------- .......... <br />Decrease ( %� <br />Time Extension Amount: <br />New Completion Date: <br />