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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 29, 2016 <br />Name Pam Mever Department <br />Community Investment <br />BPW Date August 9, 2016 Phone Extension 5845 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt, Ben Dougherty <br />Controller ® 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 />Purchasing ❑ <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 />1-I Other: <br />ired Information <br />Company or Vendor Name Indiana Housing and Community Development Authority (IHCDA) <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 />Yes Z No ❑ If Yes, Approved by Purchasing <br />MBE I-1 WBE <br />Indiana Foreclosure Prevention Network <br />State of Indiana <br />211.1001.339.03.00 DCI Dept. Admin Staff C;pontract Revenue <br />13,297.87 <br />July 1, 2016-June 30, 2017 <br />Foreclosure prevention counseling <br />referred thru IFPN <br />to those <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc <br />I Required For Change Orders Only I <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ® Pam Meyer, DCI <br />® ❑ Ben Dougherty, Legal <br />❑ ❑ <br />