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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/20/2020 <br />Name Patrick Sherman Department VPA <br />BPW Date 02/25/2020 Phone Extension 5601 <br />mncem�amu mimimmmmmmmmmimimuuuumimuuuuuumumum�mim�mmumuuuuumumuummmmuwmmmmmmmmmmmmmmmmm <br />Review andApproval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer Officer Name <br />BPW Attorney <br />Z <br />Attorney Name <br />C'lai-a McBanels <br />Dept. Attorney <br />Z <br />Attorney Name <br />Clara McDaniels <br />Purchasing Z Michael Schmidt <br />Check the Appropriate Item "Lytle —Required f6rA11 Submissions <br />L_J Professional Services Agreement LJ Contract <br />❑ <br />Open Market Contract <br />® Amendment/Addendum <br />❑ <br />Bid Opening <br />R Bid Award <br />Quote Opening <br />❑ Quote Award <br />Proposal Opening <br />C/O & PCA No. <br />�] <br />Chg. Order, No. <br />F <br />Traffic Control <br />F� 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 />ui:red Information <br />" Proposal <br />Special Purchase, QPA <br />❑j Req. to Advertise ❑ Title Sheel <br />F1 Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />Ease./Encroach <br />Lawson -Fisher Associates P.C. <br />[�' Yes❑ If Yes,mmApproved by Purchasing <br />No <br />MBE WBE Completed E-Verify Form Attached Nos <br />South Bend Parks Improvement Program Manager <br />118-012 <br />Regi !I al Cities <br />201-1111-452.42-01 <br />New total of $150,000 <br />Professional Services Agreement _ _ <br />Amendment to lower contract amount as full contract amount will not b.e ...... <br />used. <br />For C! n ge Orders O,!, l <br />Amount of El Increase $ <br />Decrease $ �....-. ........... ............... <br />Previous Amount $ <br />Increase % <br />.. <br />Current Percent of Change: Decrease ( % <br />New Amount $ <br />.._Increase.......................w......�� <br />Total Percent of Change: Decrease (mmm mmmmmmmm% <br />Time Extension Amount: <br />_.New Comaletion Date:.:. <br />