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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/15/2023 <br />Name Joseph Molnar Department DCI <br />BPW Date 08/22/23 Phone Extension 6052 <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 Michael Schmidt <br />Dept. Attorney ® Attorney Name <br />Purchasing ❑ <br />Danielle Campbell Weiss <br />Check the Appropriate Item Type — Required. for All Submissions <br />❑ Professional Services Agreement ❑ Contract ❑ 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: Transfer Agreement n Ease./Encroach <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 />Information <br />LaSalle Council, Boy Scouts of America <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />❑❑ WBE Completed E-Verify Form Attached ❑❑ Neos <br />Transfer of property to LaSalle Council, Boy Scouts of America <br />Purpose/Description Request to transfer City property off at 1340 South Bend Ave. to LaSalle <br />Council, Boy Scouts of America for expansion of the services offered by the <br />Boy Scouts at their South Bend location near Fredrickson Park. <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 />