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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/20/17 <br />Name Lory Timmer Department DCl <br />B_PW Date 12/12/17 Phone Extension 5841 <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 />r] Agreement <br />N Contract H Proposal H Addendum <br />F-1 Professional Services <br />El Resolution <br />n Bid Opening <br />EJ Bid Award [:1 Req. to Advertise ❑ Title Sheet <br />F1' Quote Opening <br />F] Quote Award <br />[J Change Order No. <br />F-1 C/O & PCA No. PCA <br />D Ease/Encroach. <br />El Traffic Control <br />F-1 Other: Amendment <br />Company or Vendor Name 466 Works Community Development Corp. <br />New Vendor E Yes 0 No E] If Yes, Approved by Purchasing <br />MBENVBE Contractor R MBE R WBE <br />MBEANBE Contractor Requested M No R Yes Name of Company <br />Project Name New Construction Program <br />Project Number 17-JC-46 (02) <br />Funding Source Community Development Block Grant (CDB,G) <br />Account No. 212.1001.460.39.30 <br />Amount <br />Terms of Contract <br />,;, .911 1=1 I <br />1 /01 /17— 12/31/19 <br />Purpose/Description Construct one (1) singIe-family home at 209 E. Indiana to sell to a <br />low -mod income buyer <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Nan -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of [I increase $ <br />F-1 Decrease $ <br />Previous Amount $ <br />0 1 <br />Current Percent of Change: 0 <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />M <br />F-1 Judy Love <br />11 <br />11 <br />El <br />0 <br />Dispersal After Approval <br />