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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW IZEQUEs'r FORM <br />Date December 15, 2017 <br />Name Pam Meyer Department DC1 <br />December 21, 2017 <br />BPS' Date Phone Extension 5845 <br />r <br />JA <br />Legal Attorney Name Ben Dougherty <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />H Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />Quote Opening <br />F] Change Order No. <br />❑ Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />FAT <br />Terms of Contract <br />Purpose/Description <br />Previous Amount <br />1�1Contract <br />■ Resolution <br />Bid Award <br />■Quote Award <br />C/O & PCA No. <br />■Traffic Control <br />ISM � 001 Wrl I M M M "1111 <br />R Req. to Advertise [:] Title Sheet <br />ro-M <br />Indiana Housing and Community Development Authority <br />J Yes X No L] If Yes, Approved by Purchasing <br />] MBE E] WBE <br />Housing Counseling Support <br />N/A - payment TO City <br />$ 11,507.00 <br />October 1, 2017 - December 31, 2017 <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non Debarment, E-Verify, Iran, etc.) <br />increase <br />Decrease <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />Pam Meyer, DC1 <br />Imi <br />