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BOARD OF PUBIAC OR <br />AGE, NDA ITEM REVIEW REQUEST FORM <br />January 4, 2018 <br />Pam Meyer <br />January 23, 2018 <br />Department DCI <br />_BPW Date Phone Extension 5845 <br />Reg0red,'Prid ' rto Submittal Jo,p ard <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 />H Agreement <br />N Contract El Proposal M Addendum <br />F1 Professional Services <br />El <br />Resolution <br />❑ Bid Opening <br />0 <br />Bid Award El Req. to Advertise E] Title Sheet <br />Quote Opening <br />❑ Quote Award <br />Change Order No. <br />C/O & PCA No. ❑ P CA <br />Ease/Encroach. <br />F1 Traffic Control <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Indiana Housing and Community Development Authority (ITICDA) <br />Yes &I No a If Yes, Approved by Purchasing <br />VBE N_UIBE <br />1FPN Mortgage Foreclosure Counseling <br />Terms of Contract January 1, 2018- December 31, 2018 <br />Purpose/Description Fee for Service contract to provide mortgage foreclosure counsleing on <br />behalf of homeowners referred through the Indiana Foreclosure Prevention <br />Network (IFPN) <br />N Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of F-1 Increase <br />�[] Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />N <br />M <br />F-1 <br />F-1 <br />El <br />n <br />Pam <br />Dispersal After Approval <br />, DCI <br />