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BOA" OF PU13LIC WORI(S <br />AGENDA ITEM REVIEW REQUEST FORM <br />Lory Timmer <br />Department DCI <br />BPW Date 8/28/18 Phone Extension 5841 <br />.. ... . ... ....... . ... ........ <br />Required Prior to Submittal to ward <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 M <br />Agreement <br />F-1 Professional Services <br />[] Bid Opening <br />E] Quote Opening <br />F] Change Order No. <br />F Ease/Encroach. <br />F] Other: Amendment <br />Contract <br />E] Resolution <br />El Bid Award <br />F-1 Quote Award <br />F1 <br />F-1 Traffic Control <br />1= <br />R Req. to Advertise <br />El PCA <br />Company or Vendor Name South Bend Heritage Foundation <br />New Vendor El Yes H No D If Yes, Approved by Purchasing <br />MBENVBE Contractor ❑ MBE [:] WBE <br />MBE BE Contractor Requested M NoE:1 Yes Name of Company <br />Project Name Acquisition / Rehabilitation Activity <br />Project Number 17-J­C-25 (01) <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of n <br />El <br />Community Development Block Grant (CDBG) <br />212.1001 A60.39.36 <br />M� <br />".14TIMT10 <br />El Title Sheet <br />1/01/18 — 12/31/20 <br />A—cq6ire and rehabilitate the house at 220 Seebirt Place for resale to <br />a low -mod income household <br />H Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />1 ail 0 0 irza <br />Copy <br />Original <br />0❑ <br />Judy Love <br />F] <br />F1 <br />n <br />In-1 <br />