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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 29, 2016 <br />Name Pam Meyer Department 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 $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ® Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Required Information I <br />Company or Vendor Name Indiana Housing and Community Development Authority (IHCDA) <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />J Yes N No ❑ If Yes, Approved by Purchasing <br />] MBE ❑ WBE <br />Hardest Hit Funds Counseling Services <br />$ 61,800.00 <br />July 1, 2016-June 30, 2017 <br />Program administration to include but not be limited to: int; <br />triage counseling, eligibility screenings, underwiting <br />❑ Required Contractor's Certification Form Attached <br />Collusion, Non -Discrimination. Non -Debarment F-Verifv rr <br />Increase <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />® Pam <br />® <br />❑ Ben <br />For Change Orders On <br />services, <br />(Non - <br />Dispersal After Approval <br />DCI <br />