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BOARD OF PUBLIC 'WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />HMO <br />Timmer <br />Department DCI1 <br />BPW Date 4/10/18 Phone Extension 5841 <br />----- - ----- <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 />Check the Appro ,qf6,,,Ifem­,Type,_ Roqu Skmiionsss: <br />p6 #od JorA f ,, 1/ u <br />F_1' Agreement M1 Contract ❑ Proposal ❑ Addendum <br />F] Professional Services <br />F-1 Bid Opening <br />E] Quote Opening <br />Change Order No. <br />❑ Ease/Encroach. <br />Other: Amendment <br />F-1 Resolution <br />F Bid Award <br />F-1 Quote Award <br />F C/O & PCA No. <br />El Traffic Control <br />F1 Req. to Advertise <br />IN• <br />Company or Vendor Name Near Northwest Neighborhood, Inc., <br />New Vendor El Yes M No F] If Yes, Approved by Purchasing <br />MBENVBE Contractor F] MBE F] WBE <br />MBEANBE Contractor Requested Z No 0 Yes Name ofCompany <br />_ <br />Project Name Acquisition / Rehabilitation Activity <br />Project Number 17-JC-23 (01) __­ --- - ------ <br />Funding Source Community Development Block Grant (CDBG) <br />Account No. 212.1001.460.39.30 <br />Amount $165,000 <br />Terms of Contract 1/01/18 — 12/31/19 <br />El Title Sheet <br />Purpose/Description Acquire and rehab 1043 California Avenue for resale to a low -mod <br />income household <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of ❑ increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ Judy Love <br />❑ <br />El <br />E• wllll•-, <br />