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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/21/17 <br />Name _Cory Timmer Department DCI <br />BPW Date 12/12/17 Phone Extension 5841 <br />RNW(p4 Prior to, 8ubm, al rd <br />Legal Attorney Name Clara McDaniels <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 />H Agreement <br />Ll Contract <br />ILJI Proposal U Addendum <br />F-1 Professional Services <br />F-1 Resolution <br />El Bid Opening <br />F-1 Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />F] Quote Opening <br />El <br />Quote Award <br />❑ Change Order No. <br />[:1 <br />C/O & PCA No. [ ] PCA <br />❑ Ease/Encroach. <br />F-1 Traffic Control <br />Other: Amendment <br />Company or Vendor Name Near Northwest Neighborhood, Inc. <br />New Vendor M Yes El No El If Yes, Approved by Purchasing <br />MBEANBE Contractor [:] MBE [:] WBE <br />MBEANBE Contractor Requested [A No E] Yes Name of Company <br />Project Name Acquisition- Rehabilitation Program @ 829 Van Buren St <br />Project Number 16-JC-23 <br />Funding Source Community Development Block �Grant <br />Account No. 212.1001.460.39.30 <br />Amount $184,500 (contract amount remains the same) <br />Terms of Contract <br />Purpose/Description <br />Amount of El <br />El <br />1/01/16- 12/31/18 <br />Extend contract timeframe by 12 months, through 12/31/18 <br />H Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />N F-1 Judy Love <br />El 11 <br />El El <br />