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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />8/14/18 <br />Lory Timmer <br />Department DCI <br />BPW Date 8/28/18 Phone Extension 5841 <br />. . .. . ....... . .. . ............ . .............. .... <br />Legal Z Attorney Name Clara McDaniels <br />Controller z 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 Appropriate Item Type — Required for All Su bmi ssions . ..... ........❑ <br />Agreement Z Contract F-1 Proposal El Addendum <br />El Professional Services <br />F] Bid Opening <br />n Quote Opening <br />F-] Change Order No. <br />Ease/Encroach. <br />❑ Other: Amendment <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />El C/O & PCA No. <br />R Traffic Control <br />0 Req. to Advertise <br />D Title Sheet <br />Company or Vendor Name South Bend Heritage Foundation <br />New Vendor [:] Yes Z No [:1 If Yes, Approved by Purchasing <br />MBE/WBE Contractor E] MBE [] WBE <br />MBEIWBE Contractor Requested Z NoF-1 Yes Name of Company <br />Project Name Acquisition / Rehabilitation Activity <br />Project Number 17-JC-25 (02) <br />Funding Source Community Development Block Grant (CDPG) ............ <br />Account No. 212.1001.460.39.30 <br />Amount $165,000 <br />Terms of Contract 1/01/18 — 12/31/20eh Purpose/Description Acguire and - r —a 6-i li t a".. t .. e _ t he house at 1122 W. Jefferson for resale <br />to a low -mod income household <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of El increase <br />[:] Decrease <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />0 <br />Copy Original <br />E] Judy Love <br />F-1 <br />