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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 6, 2016 <br />Name Pam Meyer Department <br />Community Investment <br />BPW Date September 13, 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 $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />® Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />or Vendor Name Near Northwest Neighborhood Inc. <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE n WBE <br />Real Property Transfer Agreement <br />N/A <br />N/A <br />N/A <br />$ 1.00 <br />Transfer to occur no later than November 31, 2017 <br />Transfers property contingent upon successful IHCDA Tax Credit award in <br />February 2017 for senior housing development <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of ❑ 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 />For Chanqe Orders <br />Dispersal After Approval <br />DCI <br />Ben Dougherty, Legal. <br />