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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 26, 2017 <br />Name Michael Divita'NO <br />Department DCI <br />BPW Date November 14, 2017 <br />Phone Extension 5843 <br />Legal ❑ <br />Attorney Name <br />Controller ElController <br />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, A <br />roprlatelt�m <br />Type <br />; Required far All Sc�bmasslons ... , <br />❑ <br />Agreement <br />❑ Contract <br />Proposal ® Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ <br />CIO & PCA No. <br />PCA <br />❑ <br />Ease/Encroach. <br />❑ <br />Traffic Control <br />n <br />Other: <br />Company or Vendor Name Urban Enterprise Association of South Bend, Inc. <br />New Vendor ❑ Yes ® No ❑ if Yes, Approved by Purchasing <br />MBE/VVBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name West Side Main Streets Matching Grant Program <br />Project Number <br />Funding Source COIT <br />Account No. 404.1001.460.39.30 / 17JX01 <br />Amount $50,000 <br />Terms of Contract <br />Purpose/Description Provide extension and additional funding for fapade matching grant <br />program for Lincolnway West and Western Avenue <br />® Required Contractor's Certification Form Attached (Non <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />