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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/31/2020 <br />Name Pam Mev <br />Department DCI <br />BPW Date 2/6/2020 Phone Extension 5845 <br />iMIN r ��: arm rr �Nifffff �n"� aim ..s wiommiommmmnioio mommio imimmmmuimmmmme„ PImim0000mmnlnlnlmlmmm�nln <br />Diversity Compliance <br />and Inclusion Officer <br />and <br />Prior to Submittal to Board <br />Officer Name A.ladean. Rose <br />BPW Attorney Attorney Name Clara AleDaniels <br />—m_.................................. .awww __ ....... .__....—...__................ <br />Dept. Attorney ['� Attorney Name Sandi Kennedy <br />Purchasing <br />Michael Schmidt <br />Check the Atodae Item .l ype — �cti <br />�mProfessional Services Agreement Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />[7 Bid Opening ❑ Bid Award <br />Quote Opening ❑ Quote Award <br />Proposal Opening E C/O & PCA No. <br />Chg. Order, No. E Traffic Control <br />F-1 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 />V.._ Submissions <br />r <br />All... .__ .... <br />❑ Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />PCA <br />[� Resolution <br />O Ease./Encroach <br />❑ Title Sheei <br />St Joseph County HealthDepartment_..— ................. <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑❑ MBE Completed E-Verify Form Attached Nos <br />WBE <br />Inspections & Education for IHCDA Lead Grant <br />State Grant Fund �. ... —_ — ........ .- ...... <br />.. w <br />210.1007.460.31.06 <br />�...... . <br />$41,400 <br />4/15/2019 — 12/31/2020 <br />Contract for Lead Inspection, Lead Risk Assessment, and Clearance <br />Examination, for state lead based paint grant (via IHCDA). <br />Amount of El Increase $._ wwww �_...._......... _.............. <br />—... <br />EJ Decrease ($ <br />Previous Amount $ <br />Increase .... ....................% ..._.... �. .. <br />�...... .......... <br />.... ................. <br />Current Percent of Change: Decrease (mmmITITmmmmmmmmmm %) <br />New Amount $ <br />---------------- — ...... ........._......... <br />Increase % <br />Total Percent of Change: Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />