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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/07/2020 <br />Name Brian Donoghue Department Innovation & Technology <br />BPW Date 04/14/2020 Phone Extension 7652 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ® Officer Name Patton <br />and Inclusion Officer <br />BPW Attorney ® Attorney Name McDaniels <br />Dept. Attorney <br />Purchasing <br />® Attorney Name Kennedy <br />Check the Abbrobriate Item TvDe — <br />All Submissions <br />N Professional Services Agreement U Contract U Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Information <br />Company or Vendor Name Bankable Contact: Kyle Fawcett <kylef@bankable.org> <br />New Vendor ❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />MBE/WBE Contractor ❑ MBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Project Name Emergency Small Business Assistance <br />Project Number <br />Funding Source EDIT & Redevelopment General (Pokagon) <br />Account No. 408-1050-460.39-30 & 433.1050-460.39-30 <br />Amount $ 210,000 <br />Terms of Contract 4/14/2020 — 4/14/2022 <br />Purpose/Description Agreement for the development and execution emergency of small business <br />loan program <br />For Change Orders Only <br />Amount of ❑ Increase $ <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 />