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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11120/17 <br />Department . DCI <br />BPW Date 12/12/17 Phone Extension 5841 <br />Legal Z 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 />" Agreement <br />N Contract ❑ Proposal LJ Addendum <br />F] Professional Services <br />F-1 Resolution <br />F-1 Bid Opening <br />El Bid Award ❑ Req. to Advertise El Title Sheet <br />E] Quote Opening <br />El Quote Award <br />[:] Change Order No. <br />F-1 C/O & PCA No. ❑ P CA <br />F-1 Ease/Encroach. <br />R Traffic Control <br />E r93 IT. -TA KTI Tal ITITI IT -JOT, <br />Company or Vendor Name 466 Works Community Development Corp. <br />New Vendor <br />Yes n No [:1 If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />MBE 0 WBE <br />MBE/WBE Contractor Requested M No n Yes Name of Company <br />Project Name <br />New Construction Program <br />Project Number <br />17-JC-46 (01) <br />Funding Source <br />Community Development Block Grant__(_qp_p� <br />Account No. <br />212.1001.460.39.30 <br />Amount <br />$210,000 <br />Terms of Contract <br />1/01/17- 12/31/19 <br />Purpose/Description Construct one (1) inlejaniily_ home at 203 E. Indiana to sell to a <br />low -mod income buye <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Noni-Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of F] Increase $ <br />F] Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />M <br />F-1 <br />11 <br />11 <br />Judy Love <br />