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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/16/2019 <br />Name Brian Dono huue Department Innovation & Technolo <br />BPW Date 12/19/2019 Phone Extension 7652 <br />hmsmhh mmmiiiiii ., �0l, !'IW MV I M P@IWIWMIIill n <br />-...�....... ............... <br />Re paired Pnor to Submittal to Board <br />�.._._- _._.._.. _-...... <br />BPW Attorney E, Attorney Name <br />Dept. Attorney <br />Attorney Name Sandra Kenneth <br />PurchasingEl <br />�.�.................... ......w <br />� ..�...�.�_.���_�_._......_-w �.__... �....������. <br />....- ..... ... .. ._ ..__ ._.w.. ._.- _ __......_ .0 <br />Check the Appropriate opriate Item TTTTTT�ew Required for All Submissions <br />-.. <br />Professional Services Agreement <br />0 Contract <br />-__.. _ _...... <br />❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />Special Purchase, QPA <br />❑ Bid Opening <br />Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />El Quote Award <br />❑ Reject Bids/Quotes <br />Proposal Opening <br />[:] C/O & PCA No. <br />PCA <br />❑ Chg. Order, No. <br />F] Traffic Control <br />Resolution <br />❑ Other: <br />Ease./Encroach <br />Reauired Information <br />Company or Vendor Name 17 We <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE/WBE Contractor <br />MBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />Bloomberg Mayors Challengem _...... ................. <br />Project Number <br />n/a <br />_ITm-._ <br />............�� _ <br />Ar �.................... D <br />Bloomberg Mayors Challenge wad - Gift, �,Bequest Fund <br />Funding Source <br />217 <br />Account No. <br />217-0674-415-31.06 <br />Amount <br />$58,000 <br />Terms of Contract <br />1/6/2020 - 1/5/2021 ._ ....__..... ......... <br />Purpose/Description <br />.. --- - ... ........ ........ <br />Provide operational support for Bloomberg Mayors Challenge including <br />delivery of Phase 2 of Commuters Trust program <br />.._� <br />..._. _._ . ITITITIT._�� <br />.. <br />For Change Orders -O..�.a ly <br />.._� IT_. <br />Amount of <br />Increase $ <br />❑ <br />Decrease ($ <br />Previous AmountWWWW <br />_. <br />$ __........ WWWWWWWWW <br />Increase % <br />Current Percent of Change: <br />Decrease %) <br />New Amount <br />$ <br />_._..................���� <br />............ .w....... o.........��_.......... _ <br />Increase /o <br />Total Percent of Change: <br />Decrease %) <br />Time Extension Amount: <br />New Completion Date: <br />