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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/23/20 <br />Department DCI <br />Name Liz Maradik <br />BPW Date 7/28/20 Phone Extension x5821 <br /> <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name Sandi Kennedy <br /> <br />Purchasing <br />Check the Appropriate Item Type – Required for All Submissions <br />Professional Services AgreementContractProposal <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 OpeningC/O & PCA No. PCA <br />Chg. Order, No. Traffic Control Resolution <br />Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name Cross Community, Inc. <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE Yes <br />MBE/WBE Contractor Completed E-Verify Form Attached <br />WBE No <br />Project NamePilot Housing Subsidy Program <br />Project Number <br />Funding Source EDIT <br />Account No. <br />Amount N/A –not impacted <br />Terms of ContractN/A – not impacted <br />Purpose/DescriptionFirst Amendment to the Agreement – adding and modifying some language <br />(non-substantive modifications) <br />_______________________________________________________________ <br />_______________________________________________________________ <br />_________________________________________________ <br />For Change Orders Only <br />$ <br /> Increase <br />Amount of <br /> Decrease ($ ) <br />Previous Amount$ <br />% <br />Increase <br />Decrease ( %) <br />Current Percent of Change: <br /> <br />New Amount $ <br />% <br />Increase <br />Decrease ( %) <br />Total Percent of Change: <br /> <br />Time Extension Amount: <br />New Completion Date: <br />