HomeMy WebLinkAboutPSA - Terry Stokes - Workforce Development Program Coordinator1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND. INDIANA 46601-1830
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CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
December 13, 2016
Terry Stokes
715 Pipestone
Benton Harbor, MI 49022
PHONE 574/235-9251
FAX 574/235-9171
RE: Professional Services Agreement — Workforce Development Program Coordinator
Dear Mr. Stokes:
The Board of Public Works, at its meeting held on December 13, 2016, approved the above
referenced agreement in the amount of $80,000.
Enclosed please find a copy of the agreement for your records.
If you have any further questions regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
44i42�- -��
Linda M. Martin, Clerk
Enclosure
c: Sarah Heintzelman, Community Investment
Brian Pawlowski, Community Investment
Judy Love, Community Investment
GARY A. G1LOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU
AGREEMENT FOR WORKFORCE PROGRAM MANAGEMENT SERVICES
THIS AGREEMENT FOR WORKFORCE PROGRAM MANAGEMENT
SERVICES (this "Agreement") is made effective the 13th day of December, 2016 (the
"Effective Date"), by and between the City of South Bend, Indiana, a municipal
corporation organized and operating under the laws of the State of Indiana, acting by and
through its Board of Public Works (the "City"), and James T. Stokes, a Michigan resident
whose address is 715 Pipestone, Benton Harbor, MI 49022 (the "Provider").
RECITALS
WHEREAS, the City desires to promote opportunities for local employers to recruit
potential employees and has established or assisted in certain workforce development
programs; and
WHEREAS, to facilitate and enhance the City's efforts in growing local
employment opportunities, including through certain workforce development programs,
the City desires to engage a program coordinator responsible for managing the recruitment
of candidates and serving as a single point of contact for community partners engaged in
workforce development efforts; and
WHEREAS, the Provider is duly qualified to provide the workforce program
management services set forth in attached Exhibit A (the "Services"); and
WHEREAS, the City believes that the actions contemplated by this Agreement are
in the best interests of the health, safety, and welfare of the City and its residents.
NOW THEREFORE, for and in consideration of the mutual covenants and
promises contained herein, the City and the Provider hereby agree as follows:
1. Contract Amount and Term. The Provider will provide the Services in
accordance with the terns of Exhibit A for the period commencing on the Effective Date
of this Agreement and ending on December 31, 2017 (the "Services Term"). In accordance
with the terms and conditions of this Agreement, the City will expend an amount not to
exceed Seventy Thousand Dollars ($70,000.00) (the "Contract Amount") for the
Provider's performance of the Services during the Services Term.
2. Budret: Expenses. The Provider will not seek from the City, and the City
will not pay to the Provider, any amount in excess of the Contract Amount as compensation
for the Provider's performance of the Services or for any costs or expenses related to the
Services. Upon approved receipt, the City agrees to reimburse Provider with an amount
not to exceed Ten Thousand Dollars ($10,000.00) for marketing expenses. It is understood
by the Provider that such reimbursements are not guaranteed and such expenses must be
pre -approved by the City prior to any reimbursement. All other non -marketing costs or
expenses related to the Provider's performance of the Services will be paid by the Provider
1
and will not be reimbursed by the City.
3. Compensation for Services. The Provider will submit monthly reports using
the matrix included in Exhibit A. As compensation for the Provider's satisfactory
performance of the Services, the City will pay the Contract Amount in equal monthly
installments (each a "Contract Installment") in the manner stated in Exhibit A. The City
will not be required to pay any Contract Installment if the City is not satisfied with the
Provider's performance under this Agreement or any default or breach of this Agreement
by the Provider exists, as the City may determine in its sole discretion. The sum of all
Contract Installments will not exceed the Contract Amount.
4. Termination of Agreement. Effective immediately upon delivery of a
written termination notice to the Provider, the City may terminate this Agreement, in whole
or in part, for any reason, if the City determines that such termination is in the best interest
of the City. If the City Controller makes a written determination that funds are not
appropriated or are otherwise unavailable to support the continuation of this Agreement, it
shall be cancelled. A determination by the City Controller that funds are not appropriated
or are otherwise unavailable to support the continuation of performance shall be final and
conclusive. The City will not be required to pay any Contract Installment or be otherwise
liable for any cost associated with the Provider's performance of any Services after the
effective date of termination.
5. Remedies for Breach of Contract. Failure to complete the Services in
accordance with this Agreement may be considered a material breach, and shall entitle the
City to impose sanctions against the Provider including, but not limited to, suspension of
all payments, and/or suspension of the Provider's involvement in the workforce program
management on behalf of the City. The Provider shall repay any portion of the Contract
Amount expended for matters not within the scope of the Services.
6. Maintenance of Records. Access to Records. The Provider shall keep a
written record, in a form acceptable to the City, related to the use and expenditure of the
Contract Amount. Within thirty (30) days of the expiration or termination of this
Agreement, the Provider shall provide the City with a final accounting of the use and
disposition of the Contract Amount by the Provider. Unless otherwise authorized by the
City or required by law, such records shall be maintained by the Provider for a period of
four (4) years of the date of this Agreement. The Provider understands and agrees to
comply with the legal requirements of I.C. 5-14-3-1 et seq. (commonly known as Indiana's
Access to Public Records Act), if applicable, with respect to all documentation related to
the Contract Amount.
7. Audit Rgguirements. The Provider agrees to make all information available
to the Indiana State Board of Accounts, the City's Internal Auditor (as defined below), and
the Contract Administrator (as defined in Section 11 below) as requested to comply with
any review related to the receipt and use of the Contract Amount and the Provider's
performance of the Services. If requested by the City or the Contract Administrator, the
Provider shall provide the City a progress report on the Services. If requested by the City
2
or the City's Internal Auditor, the Provider shall arrange for a financial and compliance
audit of the Contract Amount to be conducted by an independent public or certified public
accountant (or as applicable, the Indiana State Board of Accounts) and in accordance with
applicable Indiana State Board of Accounts standards. The City's Internal Auditor shall
mean the City Controller or Acting City Controller appointed pursuant to I.C. 36-4-9-6 (the
"City Controller") or any person appointed or retained by the City Controller or the City
for the purpose of auditing this Agreement or other agreements of the City.
8. Conflicts of Interest. The Provider hereby certifies and agrees that no
member, officer, or employee of the City, or its designees or agents, and no member of the
governing body of the City of South Bend or the Provider (and no one with whom there is
a family or business tie) who exercises any functions or responsibilities with respect to the
receipt and use of City funds during his or her tenure or for one year thereafter, shall have
any financial benefit, direct or indirect, in any contract or subcontract, or the proceeds
thereof, for work to be performed in connection with this Agreement or the Services. The
City acknowledges that its officers and employees are "public servants" within the meaning
of I.C. 35-31.5-2-261. The City hereby represents and certifies that it may enter into this
Agreement under I.C. 35-44.1-1 et seq. and, to the extent applicable, the City will cause to
be prepared any required Uniform Conflict of Interest Disclosure Statement in the form
attached hereto as Exhibit B.
9. Relationship. The Provider shall at all times be an independent contractor
for the performance of the Services rather than an employee of the City, and no act or
omission to act by the Provider shall in anyway bind or obligate the City. This Agreement
is strictly for the benefit of the parties and not for any third -party or person. This
Agreement was negotiated by the parties at arm's length and each of the parties hereto has
reviewed the Agreement after the opportunity to consult with independent legal counsel.
Neither party shall maintain that the language in the Agreement shall be construed against
any signatory hereto. The City and the Provider hereby renounce the existence of any form
of agency relationship, joint venture, or partnership between the Provider and the City and
agree that nothing contained herein or in any document executed in connection herewith
shall be construed as creating any such relationship between the City and the Provider.
10. Indemnification. The Provider hereby agrees to defend, indemnify, and
hold harmless the City, its officials, employees, and agents from any and all claims of any
nature which arise from the performance by the Provider under this Agreement and from
all costs and attorney fees in connection therewith, excepting for claims arising out of the
negligence of the City, its officials, directors, employees, and agents. The obligations of
the Provider under this Section shall survive the termination of this Agreement.
11. Notices. Any notice required or permitted to be delivered hereunder shall
be deemed to be delivered, whether or not actually received, when deposited in the United
States Postal Service, postage prepaid, registered or certified mail, return receipt requested,
addressed to the City or the Provider, as the case may be, at the address set forth below.
Provider: Cam:
James T. Stokes Brian Pawlowski (the "Contract Administrator")
3
715 Pipestone Department of Community Investment
Benton Harbor, MI. 49022 City of South Bend
227 W. Jefferson Boulevard, Suite 1400 S
South Bend, IN 46601
12. EE ual 0DDortunity. The Provider shall comply with federal, state, and local
law in its hiring and employment practices and policies for any activity covered by this
Agreement.
11 Entire Agreement and Amendment: Applicable Law. This Agreement sets
forth the entire agreement and understanding between the parties as to the subject matter
hereof, and merges and supersedes all prior discussions, agreements, and understanding of
any and every nature between them. This Agreement may be amended only by separate
writing, approved by authorized representatives of both the Provider and the City. This
Agreement will be construed and interpreted according to the laws of the State of Indiana.
14. Assignment. The Provider shall not assign or subcontract the whole or any
part of this Agreement or its obligations hereunder without the prior written consent of the
Board of Public Works of the City.
15. Non -Collusion. The undersigned attests, subject to the penalties of perjury,
that he is the Provider and that he has not entered into or offered to enter into any
combination, collusion, or agreement to receive or pay, and that he has not received or
paid, any sum of money or other consideration for the execution of this Agreement other
than that which appears upon the face hereof. The Provider agrees that he will execute and
submit to the City and any other appropriate bodies, an affidavit in the form attached hereto
as Exhibit C.
16. Drug -Free Workplace. The Provider hereby agrees to make a good faith
effort to provide and maintain a drug -free workplace. The Provider will give written notice
to the City within ten (10) days after receiving actual notice that the Provider or an
employee of the Provider within the State of Indiana has been convicted of a criminal drug
violation occurring in the workplace.
17. E-Veri . The Provider hereby certifies that it does not and will not knowingly
employ or contract with an unauthorized alien, nor retain any employee or contract with a
person that the Provider subsequently learns is an unauthorized alien. The Provider agrees that
he/she/it shall enroll in and verify the work eligibility status of all ofthe Provider's newly hired
employees through the E-Verify program as defined by I.C. 22-5-1.7-3.
(Signature page follows)
IN WITNESS WHEREOF, the Parties hereto have caused this Agreement to be
effective as of the Effective Date stated above.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Date: -2 e.7µ Q t . 0 , 2016
0
Gary A. Gilo , President
Therese Doran, MerWer
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Elizabeth Maradik, Member
L zt'
J s Mueller, Member
Memb r
ATTEST J
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da M. Martin
JAMES T. STOKES, a Michigan
resident
Date: Al ..6-� ,2016
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Printed Name
EXHIBIT A
Scope of Work
[See attached.]
EXHIBIT B
Uniform Conflict of Interest Disclosure Statement
[See attached.]
EXHIBIT C
Contractor's Affidavit
[See attached.]
Scope of Work
In 2016 the Pathways program grew to include six specific training programs, covering four sectors. The
current expectation is the program will graduate 100 people by the end of the year. This is over double
the 2015 number of 40. The role of a dedicated program coordinator has been crucial to this growth.
During 2016 the program coordinator was able to recruit and engage numerous candidates who were
not currently active in the labor force or who were looking to upskill to a career track that has increased
growth potential. In an effort to continue this momentum and reach additional candidates, we are
extending the contract of the coordinator who will manage the program, handle recruitment and
management of candidates
Goal:
This scope of work outlines and defines the expectations of the awarded contractor who will act as the
coordinator for the 2017 Pathways program. The contractor will recruit residents for training in high
demand sectors. Targeted populations for the program should include demographics that have higher
than average unemployment in the City and are seen as underserved. The expectation is the
coordinator will act as a single point of contact for the program; managing recruitment, coordination,
and follow-up with all stakeholders and candidates.
Strategies:
Phase I: Resource Mapping
• Define and create pathways for growth, including clear tracks for future advancement, all
pathways will lead to opportunities for employment
o Training will be sector specific, with identified milestones that can be used individually
or that can be built upon. For example, candidates in CNA training will be able to use
the training as either a standalone credential for employment upon completion or may
continue on with a CNA certification as a foundation for additional training through an
RN degree
• Maintain a virtual database for tracking
o The database should be accessible to all partners so that information can be uploaded
and viewed by all stakeholders at any time
o The information included should reflect the reporting metrics used to evaluate the
program, information should be updated on the Is' and 15t^ of every month or/and at
the beginning and end of every class
o WorkOne will report to the program coordinator the following:
• Number enrolled
• Number of successfully completed trainings
• Number in on the job training when applicable
• Number transitioned from on the job training to full time employment when
applicable
• Number of candidates hired
• Candidate retention rate/aggregate wage increase
o The City will download data every two weeks for reporting
Phase II: Community Connections
Maintain current valuable community partnerships to reach previously underserved
populations, while expanding partnership base to increase participation. New and existing
connections will be reported monthly to gauge participation and outreach.
o Community partners should have clear expectations of roles in program. For example,
local churches who participate will do outreach in their congregations for recruitment
and will provide names and accurate contact information for any potential candidates
o They may also host events with the program representative to spark interest and
provide information for interested individuals
o All partners will meet monthly to ensure clear communication, address any concerns,
and to determine any needed steps
Phase III: Program Implementation
Coordinate with WorkOne to handle referral management, training, placement, and tracking
o WorkOne will act as a case manager for individuals in the program; handling drug
testing, Work keys testing, setting up curriculums, and assisting in placement upon
program completion
o The program coordinator will act as a single point of contact between the City,
community partners, WorkOne, and candidates
Expand current marketing plan and materials for advertising, outreach, and recruitment
o The program coordinator will submit an updated marketing plan for approval to the City
that includes materials that will be used for recruitment
o When necessary the program coordinator will provide presentations for groups to
engage potential candidates
• Recruit 80-100 people to complete training in any of the City sponsored workforce programs
o All candidates should be City residents —with a primary focus on underserved
populations
Phase IV: Follow Up
• Manage candidate follow-up to track interviewing, hiring, and placement outcomes
o All candidates will need to have progress tracked from program entry to job placement,
with information recorded on training, interviewing, and placements
o Professional resumes will be written by WorkOne and uploaded to the database to be
reviewed by the Program Coordinator
Candidates will need to provide surveys upon completion of the program that can be
used for evaluation in future endeavors
• The program coordinator will submit invoices monthly for payment
o Invoices will have a 30 day turn -around time, consistent with City policy
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT,
CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY
VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE
OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF r )
) SS:
e(s' e COUNTY )
The undersigned Contractor, being duly swom upon his/her/its oath, affirms under the penalties of perjury that:
1. Contractor has not, nor has any other member, representative, or agent of the firm,
company, corporation or partnership represented by him, entered into any combination, collusion
or agreement with any person relative to the price to be bid by anyone at such letting nor to
prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid
is made without reference to any other bid and without any agreement, understanding or
combination with any other person in reference to such bidding. Contractor further says that no
person or persons, firms, or corporation has, have or will receive directly or indirectly, any
rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its
principals are presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any Federal department or agency;
and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency or
instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from
time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is
engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty million
dollars ($20,000,000) or more in value in the energy sector of Iran; or
ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty
million dollars ($20,000,000) or more in credit to another person for forty-five (45)
days or more, if that person will (i) use the credit to provides goods and services in
Non-Collusim Non -Debarment Affidavit Non Imo Forth
the energy sector in Iran; and (ii) at the time the financial institution extends credit, is
a person identified on list published by the Indiana Department of Administration.
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the Contractor subsequently learns is an
unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility
status of all of Contractor's newly hired employees through the E-Verify Program as defined by
I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify
Program is included and attached as part of this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public
contract to certify that the subcontractors do not knowingly employ or contract with an
unauthorized alien, nor retain any employee or contract with a person that the subcontractor
subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is
participating in the E-Verify Program. The Contractor agrees to maintain this certification
throughout the term of the contract with the City of South Bend, and understands that the City
may terminate the contract for default if the Contractor fails to cure a breach of this provision no
later than thirty (30) days after being notified by the City.
6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by
the City of South Bend through its agencies, boards, or commissions shall not discriminate
against any employee or applicant for employment in the performance of a City contract with
respect to hire, tenure, terns, conditions, or privileges of employment, or any matter directly or
indirectly related to employment because of race, sex, religion, color, national origin, ancestry,
age, gender expression, gender identity, sexual orientation or disability that does not affect that
person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials,
or any combination of the foregoing including, but not limited to, public works contracts
awarded under public bidding laws or other contracts in which public bids are not required by
law, the City, its agencies, boards, or commissions may consider the Contractor's good faith
efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority
Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining
the lowest, responsible, responsive bidder.
In no event shall persons or entities seeking the award of a City contract be required to award a
subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said
WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board
shall prohibit that person or entity from being awarded a City contract for a period of one (1)
year from the date of such determination, and such determination may also be grounds for
terminating the contact for which the discriminatory practice or noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination commitment
shall be made a part of any contract which it may henceforth enter into with the City of South
Bend, Indiana or any of its agencies, boards or commissions.
Nan -Collusion Non -Debarment Affidavit Non Iran Form
Contractor agrees not to discriminate against or intimidate any employee or applicant for
employment in the performance of this contract with privileges of employment, or any matter
directly or indirectly related to employment, because of race, religion, color, sex, gender
expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of
this provision may be regarded as material breach of contract.
I, the undersigned bidder or agent as contractor on a public works project, understand my
statutory obligations to the use of steel products or foundry products made in the United States
(I.C. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will
use steel products or foundry products on this project if awarded. I understand that violations
hereunder may result in forfeiture of contractual payments.
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for
public works are true and correct.
Dated this day of Utee,wd 20L�
Co ac der (F'
Signe of ContractgiBidder or Its Agent
;l aYit>°z T Spa �s
Printed Name and Title
Subscribed and sworn to before me this day of 20_
My Commission Expires
Notary Public
County of Residence f [(I
Non -Collusion Non -Debarment Affidavit Non Iran Fonn
UNIFORM CONFLICT OF INTEREST DISCLOSURE STATEMENT
,State Fame 64266 (R / 6-12) / Form 236
STATE BOARD OF ACCOUNTS
Indiana Code 35-44.1-1-4
A public servant who knowingly or intentionally has a pecuniary interest in or derives a profit from
a contract or purchase connected with an action by the governmental entity served by the public servant
commits conflict of interest, a Class D Felony. A public servant has a pecuniary interest in a contract or
purchase if the contract or purchase will result or is intended to result in an ascertainable increase in the
income or net worth of the public servant or a dependent of the public servant. "Dependent" means any
of the following: the spouse of a public servant; a child, stepchild, or adoptee (as defined in IC 31-9-2-2)
of a public servant who is unemancipated and less than eighteen (18) years of age; and any individual
more than one-half (112) of whose support is provided during a year by the public servant.
The foregoing consists only of excerpts from IC 35-44.1-1-4. Care should be taken to review IC
35-44.1-1-4 in its entirety.
1. Name and Address of Public Servant Submitting Statement:
2. Title or Position With Governmental Entity:
3. a. Governmental Entity:
b. County:
4. This statement is submitted (check one):
a._ as a "single transaction" disclosure statement, as to my financial interest in a specific contract or
purchase connected with the governmental entity which I serve, proposed to be made by the
governmental entity with or from a particular contractor or vendor; or
b._ as an "annual" disclosure statement, as to my financial interest connected with any contracts or
purchases of the governmental entity which I serve, which are made on an ongoing basis with or
from particular contractors or vendors.
5. Name(s) of Contractor(s) or Vendor(s):
6. Description(s) of Contract(s) or Purchase(s) (Describe the kind .of contract involved, and the
effective date and term of the contract or purchase if reasonably determinable. Dates required if 4(a)
is selected above. If "dependent" is involved, provide dependent's name and relationship):
7. Description of My Financial Interest (Describe in what manner the public servant or 'depen-
dent' expects to derive a profit or financial benefit from, or otherwise has a pecuniary interest in,
the above contract(s) or purchase(s); if reasonably determinable, state the approximate dollar
value of such profit or benefit):
(Attach extra pages if additional space is needed.)
8. Approval of Appointing Officer or Body (To be completed if the public servant was appointed by
an elected public servant or the board of trustees of a state -supported college or university.):
I (We) being the of
(Title of Officer or Name of Governing Body)
and having the power to appoint
(Name of Governmental Entity)
the above named public servant to the public position to which he or she holds, hereby approve the
participation to the appointed disclosing public servant in the above described contract(s) or
purchase(s) in which said public servant has a conflict of interest as defined in Indiana Code 35-
44.1-1-4; however, this approval does not waive any objection to any conflict prohibited by statute,
rule, or regulation and is not to be construed as a consent to any illegal act.
Elected Official Office
9. Effective Dates (Conflict of interest statements must be submitted to the governmental entity prior
to final action on the contract or purchase.):
Date Submitted (month, day, year) Date of Action on Contract or Purchase (month, day, year)
10. Affirmation of Public Servant: This disclosure was submitted to the governmental entity and
accepted by the governmental entity in a public meeting of the governmental entity prior to final
action on the contract or purchase. I affirm, under penalty of perjury, the truth and completeness of
the statements made above, and that I am the above named public servant.
Signed:
(Signature of Public Servant)
Date:
(month, day, year)
Within fifteen (15) days after final action on the contract or purchase, copies of this statement must be
filed with the State Board of Accounts, Indiana Government Center South, 302 West Washington Street,
Room E418, Indianapolis, Indiana, 46204-2765 and the Clerk of the Circuit Court of the county where the
governmental entity took final action on the contract or purchase.
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date December 6. 2016
Name Sarah Heintzelman Department Comm Inv
BPW Date December 13, 2016 Phone Extension 5842
Required Prior to Submittal to Board
Legal ® Attorney Name Michael Schmidt
Controller review is required for all Contracts $5,000.00 or more
Controller ❑ and greater than one year in length per the City Purchasing
Policy
Purchasing ❑
Check the Appropriate Item Type — Required for All Submissions
❑ Agreement ® Contract ❑ Proposal ❑ Addendum
❑ Bid Opening
❑ Quote Opening
❑ Chg Order No.
Ease./Encroach
Other:
Company or
New Vendor
Name
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Amount of
❑ Bid Award
❑ Quote Award
❑ C/O & PCA No.
❑ Traffic Control
❑ Req. to Advertise ❑ Title Sheet
Information
❑ PCA
Resolution
Claim
Terry Stokes
❑ Yes ❑ If Yes, Approved by Purchasing
® No
❑ MBE Completed E-Verify Form Attached El Yes
❑ WBE ❑ No
Workforce Development Program Coordinator
EDIT
408-1001-460-31.06
$ 80,0000
Coordination of workforce efforts to maintain a single point of
contact for organization and recruitment.
For Change Orders Only
Increase $
Decrease $
Previous Amount $
Current Percent of Change: %
New Amount $
Total Percent of Change: %
Dispersal After Approval
Copy
® Sarah Heintzelman, Community Investment
® Brian Pawlowski, Community Investment
® Judy Love, Community Investment