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BOARD OF PU13LIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 8, 2018 <br />Name <br />Pam Meyer <br />Department <br />ICI <br />BPW Date <br />March 27, 2018 <br />Phone Extension <br />5845 <br />Legal Z Attorney Name Elliott Anderson, Clara McDaniels <br />Controller El 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 L Contract Ll Proposal M Addendum <br />F-1 Professional Services El Resolution <br />n Bid Opening F-1 Bid Award Req. to Advertise ❑ Title Sheet <br />El Quote Opening n Quote Award <br />Change Order No. F-1 C/O & P,CA No. F-1 PCA <br />❑ Ease/Encroach. El Traffic Control <br />❑ Other: <br />Comipany or Vendor Name Urban Enterprise Association of South Bend, Inc. <br />New Vendor <br />El Yes 0 No El If Yes, Approved by Purchasing <br />MBE[WBE Contractor <br />F MBE F WBE <br />Project Name <br />N/A <br />Project Number <br />N/A <br />Funding Source <br />N/A <br />Account No. <br />N/A ... ....... . ... - <br />Amount <br />$0.00 <br />Terms of Contract <br />I/l/18-12/31/18 <br />Purpose/Description <br />To extend Agreement for V2V Reapir Matching Grant Program for <br />Homeowners and Landlords <br />[:] Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Mon -Debarment, E-Verifv, Iran, etc.) <br />Amount of [I increase $ <br />F-1 Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy Original <br />Pam M <br />El <br />Dispersal After Approval <br />, DCI <br />