Laserfiche WebLink
Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />November 18, 2016 <br />Pam <br />Department Community Investment <br />BPW Date December 13, 2016 Phone Extension 5845 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt, Andrea Huntington <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />I Check the Appropriate Item Type — Required for All Submissions <br />JZ,J Agreement U Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I -I Other: <br />I Required Information <br />Company or Vendor Name Urban Enterprise Association of South Bend, Inc. <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />J Yes N No LJ If Yes, Approved by Purchasing <br />] MBE ❑ WBE <br />V&A Repair Grant Program <br />EDIT <br />408.1001.460.39.30 <br />$ 39,000 added to existing $96,500 for total of $135,000 <br />January 1, 2017- December 31, 2017 <br />Additional funds for grant program available to homwoeners and landlords <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 />For Chanqe Orders On <br />Dispersal After Approval <br />Pam Meyer, DCl/UEA <br />Andrea Huntington, Legal <br />