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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/5/2020 <br />Department <br />Name ..l"I�nl °fever, DCI <br />BPW Date Fel�rur 25 21'120 Phone Extension 5845 <br />— m,�rmnruimr�mmmnu.�mmr�wuumwuuiuwiwnwuiuiumwn, uranim�iuw;wr�.rmwmwv�MI imrmrm; mmnmmnmmnmmnmmmn�lvppi <br />Review and fr!pvl ldgifited Prior to Submittal to Board W <br />Diversity Compliance Officer Name M. Patton � <br />and Inclusion Officer <br />BPW Attorney <br />Dept. Attorney <br />/1 <br />Purchasing <br />Check th <br />Attorney Name __....me Clara McDanlels <br />Attorney Name Sandra Kennedy <br />Ll Professional Services Agreement ,]! Contract <br />F] Open Market Contract ❑ Amendment/Addendum <br />0 Bid Opening [] Bid Award <br />Quote Opening El Quote Award <br />[] Proposal Opening n C/O & PCA No. <br />❑ Chg. Order, No. El Traffic Control <br />Ja Other: <br />-_ Reauired Informatio <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 />Purpose/Description <br />qr. All ,Submissions <br />[J Proposal <br />El Special Purchase, QPA <br />Req. to Advertise ❑ Title Sheei <br />E] Reject Bids/Quotes <br />F] PCA <br />❑ Resolution <br />Ease./Encroach <br />Indiana t tm uic�u�;tit and Cotntn�tnli ....Dcv l tl�t �ti that 1t .Aj......... <br />YesE] If Yes, Approved by Purchasing <br />❑❑ No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑j No <br />Indiana Foreclosure PreventionwNctwosl� 11 1, w'rtt�clit.lmm. <br />".._ _.. m... . <br />fate f is y l of cc���nseh based on Fees i n 1 xli iltt <br />January,..1 , 020 December 31, 2020 <br />To_provide services t _o those homeowners nee wwwwww ding counseling„ and referrec <br />t <br />the IFPN <br />71 <br />pp,, <br />Amount of <br />El <br />increase <br />Decrease <br />$ ..�� ___........._�.�...... <br />($ ) <br />—. _.. <br />Previous Amount <br />$ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Increase <br />% <br />Decrease <br />( % <br />^Increase u <br />%... <br />............................o....... <br />Decrease <br />/o <br />