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BOARD OF PUBLIC WORKS <br />AGEjgD.A f'FENT REVIEW REQUEST CORM <br />Date 38/1 W20 i 6 <br />Name Caitivn Chase <br />Department Admin & Finance/HR <br />BPW Date 08/23/2016 Phone Extension 9997 <br />Legal <br />Controller <br />Purchasing <br />Required Prior to Submittal to Board <br />[XI Attorney Name Michael Schmidt <br />❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Check the Appropriate Item Type — ,Required for All Submissions <br />® Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Information <br />Company or Vendor Name <br />New Avenues <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name <br />Employee Assistance Program (EAP) <br />Project Number <br />Funding Source <br />Health Insurance Fund <br />Account No. <br />711-0401-671-34-13 <br />Amount <br />$ 3.55 per employee per month <br />Terms of Contract <br />Agreement is for a one year period (2017). <br />Purpose/Description <br />EAP full service based upon 1,112 employees at a <br />utilization rate. Services will include: short-term counseling EAP <br />orientation training, telephonic consultation management referral <br />program, critical incident response work -life resource center, <br />brochures. and 4 hours of trainings/workshops <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Chanqe Orders Only <br />Amount of U Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />John Murphy, Jennifer Hockenhull, Janet Cadotte, Caitlyn Chase <br />