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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/03/16 <br />Name Lory Timmer Department DCI <br />BPW Date 8/23/16 Phone Extension 5841 <br />Legal ® <br />Attorney Name <br />Michael Schmidt <br />Controller ® <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 />Purchasing <br />�— Check the Appropriate Item Type <br />❑ Agreement ® Contract <br />Required forAll Submissions —� <br />❑ Professional Services <br />❑ Resolution <br />❑ Proposal ❑ Addendum <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Bid Award <br />❑ Quote Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />❑ PCA <br />❑ Other: Amendment <br />Kequired Information <br />Company or Vendor Name Department of Community Investment <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name South Bend Home Improvement Program <br />Project Number 16-JC-0.5 <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Block <br />212.1001 <br />1/01/16 — 12/31/17 <br />Provide essential home repairs for low -moderate income homeowners <br />® Required Contractor's Certification Form Attached (Non - <br />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 />❑ <br />❑ <br />Love <br />For Change Orders <br />70 <br />70 <br />Dispersal After Approval <br />