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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/6/2020 <br />Name Adam Parsons Department Central Services <br />BPW Date 1/14/2020 Phone _ � .......... ����..�� �.. .�� ......_....... <br />� � N Extension 9302 <br />w Review r to Submittal to Board .�. <br />Diversity Compliance ❑ <br />Officer Naml�ered Pno .___,�._..�.�.... �. ._....�.w _........ .. <br />and Inclusion Officer <br />......._.. .. Y ® _ Attorney Name ._. �. ........_ ._.......... _m_ ._.......� ......� <br />BPW Attorney Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />.......... <br />. _ ..... <br />Purchasing ® Michael. Schmidt <br />Check the Appropriate Item Twe w <br />uired Mr All Submissions <br />LJ Open Market Contract gr El E Contract <br />m-_ ... ..... .__... — ... <br />LJ Professional Services Agreement <br />Amendment/Addendum <br />❑ Bid Opening El Bid Award <br />Quote Opening Quote Award <br />Proposal Opening j C/O & PCA No. <br />�j Chg. Order, No. Traffic Control <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Information <br />Proposal <br />LJ Special Purchase, QPA <br />E] Req. to Advertise <br />Reject Bids/Quotes <br />(� PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />Yes If Industrial Door y of Northern Indiana, , Inc. <br />_ �....._.. _ ..._. _ _. <br />❑ es, Approved by Purchasing <br />® No <br />MBE Completed E-Verify Form Attached � Yes <br />WBE ❑ No <br />City -Wide Overhead Door Services <br />i ........._ _. _.. Accounts <br />Individual Departmental Maintenance A __...... ..... <br />TBD (see attached for hourly rates <br />w years, with an option wfor an additional 2 years <br />To streamline and stand a rdize cit -wide overhead door re air services. <br />For Cha l_ge Orders Only <br />....._. .. _da m._ E_.. _ . _......._wa .... _. <br />AIncrease $ <br />Amount of <br />�... ... <br />Decrease <br />Previous Amount <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount:. <br />New Completion Date: <br />