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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/15/16 <br />Lory Timmer <br />Department DC] <br />BPW Date 12/27/16 Phone Extension 5841 <br />Re uirad Prior to Submittal fio 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 />® <br />Agreement <br />❑ <br />Contract ❑ Proposal ❑ Addendum <br />❑ <br />❑ <br />Professional Services <br />Bid Opening <br />❑ <br />❑ <br />Resolution <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Change Order No. <br />❑ <br />C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ <br />Traffic Control <br />n <br />Other: Amendment <br />Company or Vendor Name Northeast Neighborhood Kevitalization Vrganization, mc. <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 Agreement for Programs and Services <br />Project Number <br />Funding Source EDIT <br />Account No. 408.1001.460.39.30 <br />Amount $75,000 <br />Terms of Contract 1/01/17 — 12/31/17 <br />Purpose/Description Support the NNRO's revitalization efforts in South Bend's Northeast <br />Neighborhood <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase 4i <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 />