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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW REQUEST FORM <br />Date 5/25/18 <br />Name Lory Timmer <br />BPW Date 6/12/18 <br />...... . ..... ... <br />. ...... Department _DCI <br />Phone Extension_ 5841 <br />........... ... . ... .. ...... ............ . .. . .... . .... . <br />Required Prior to Submittal to Bcard <br />Legal Z <br />Attorney Name Clara McDaniels <br />Controller z <br />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 M <br />Check the Appropriate Item Typo — Required forAll'Subroissions <br />F-1 Agreement <br />Z Contract ❑ Proposal ❑ Addendum <br />n Professional Services <br />F-1 Resolution <br />F-1 Bid Opening <br />El Bid Award F] Req. to Advertise ❑ Title Sheet <br />F] Quote Opening <br />El Quote Award <br />E] Change Order No. <br />F-1 C/O & PCA No. F-1 PCA <br />El Ease/Encroach. <br />❑ Traffic Control <br />In Other: Amendment <br />Company or Vendor Name Near Northwest Neighborhood, Inc. <br />New Vendor [:] Yes 0 No E] IIf Yes, Approved by Purchasing <br />MBEANBE Contractor F-1 MBE [:] WBE <br />MBENVBE Contractor Requested M No F-1 Yes Name of Company <br />Project Name Acquisition / Rehab Activity . ..... <br />Project Number 17-JC-23 (02) <br />Funding Source Community Development Block Grant (CDBG) <br />Account No. 212.1001.460.39.30 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />$165,000 <br />1/01/18 — 12/31/19 <br />Acquire and rehab the house at 1008 California Avenue to sell to a <br />low -mod income buyer <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of n increase $ <br />El Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />i &I <br />IF, <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />F-1 Judy Love <br />. ......... .. <br />El El <br />