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Date 12/9/2016 <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Department PW <br />Name Therese Dorau Division/Bureau Sustainability <br />BPW Date 12/13/2016 Phone Extension X9323 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <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 010' t_ , 0 <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 />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <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 />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chance: <br />Copy <br />Origin <br />❑ <br />❑ <br />❑ <br />❑ <br />0 <br />❑ <br />red <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />Purchasina <br />WBE <br />as Name of <br />A RESOLUTION OF THE BOARD OF PUBLIC WORKS FOR <br />THE CITY OF SOUTH BEND, INDIANA TRANSFERRING ITS <br />FEDERAL HYDROPOWER PERMIT EXEMPTION <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />ired For <br />