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BOARD OF PUBLIC WORKS <br />AGFENDA ITEM REVIEW REQUEST FORM <br />Name Lory Timmer Department DC1 <br />BPW Date 8/28/18 Phone Extension 5841 <br />Reg uired Prior to Submittal to Board <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 0 <br />Agreement <br />[:] Professional Services <br />F-1 Bid Opening <br />❑ Quote Opening <br />❑ Change Order No, <br />❑ Ease/Encroach. <br />11 Other: Amendment <br />Contract <br />'F_1 Resolution <br />F-1 Bid Award <br />Quote Award <br />C/O & PCA No. <br />F1 Traffic Control <br />El Req. to Advertise F] Title Sheet <br />01=11 <br />Company or Vendor Name Department of Community Investment <br />New Vendor [I Yes M No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor R MBE [] WBE <br />MBEA/VBE Contractor Requested Z NoEl Yes Name of Company <br />Project Name South Bend/UEA Pilot Home Repair Program <br />Project Number 18-JC-05 <br />Funding Source Community Development Block Grant (CDBG) <br />Account No. 212.1001.460.39,.30 <br />Amount $200,000 <br />Terms of Contract 1 /01 /18 — 12/31/19 <br />Purpose/Description <br />Amount of F-1 <br />1:1 <br />Provide necessahome repairs for low -mod income owners <br />Z Required Contractor's Certification Form Attached (Non- <br />Coilusion, 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 />Dispersal After Approval <br />Copy Original <br />E] Judy Love <br />El ❑ <br />