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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/22/2020 <br />Department <br />Name Maurice Scott Mayor’s Office <br />BPW Date 7/28/2020 Phone Extension 9416 <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 Clara McDaniels <br />Dept. Attorney Attorney Name Jenna Throw <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 AwardReject 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 Goodwill Industries of Michiana <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 NameStreet Outreach Team Funding <br />Project Number <br />Funding Source COIT <br />Account No. 404-0801-421.31-15 <br />Amount $__No Change from Existing Agreement_________________ <br />Terms of Contract <br />Purpose/DescriptionAmendment of Existing Agreement: Temporary reallocation of how funds <br />provided under existing agreement will be spent by Goodwill Industries of <br />Michiana_______________________________________________________ <br />For Change Orders Only <br />$ <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 />Time Extension Amount: <br />New Completion Date: <br />