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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE VIEW REQUEST FORM <br />Date 8,/30/18 <br />Name, Lary Timmer ......... . ......... Department DCI <br />BPW Date 9/11/18 Phone Extension 5841 <br />Required Prior to Submittal to Board <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.100 or more and <br />Controller ❑ <br />greater than one year in length per the City Purchasing Policy <br />Purchasing M <br />Agreement <br />F-1 Professional Services <br />F] Bid Opening <br />E] Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />Other: Amendment <br />Contract <br />El Resolution <br />El Bid Award <br />F-1 Quote Award <br />E] C/O & PCA No. <br />F1 Traffic Control <br />9= <br />F-1 Req,, to Advertise <br />El Title Sheet <br />Company or Vendor Name Youth Service Bureau of St. Joseph! County, Inc. <br />New Vendor El Yes M No El If Yes, Approved by Purchasing <br />MBEANBE Contractor F] MBE F-1 WBE <br />MBE/VVBE Contractor Requested M No F-1 Yes, Name of Company <br />Project Name Emergency Shelter Operations & Rapid Rehousing Activities <br />Project Number 18-JE-35 <br />Funding Source Emergency <br />Account No. 212. 1001 A60.39.30 <br />Amount $77,406 <br />Terms of Contract 1/01/18 — 3/11/20 -i6i6ency shelter for <br />Purpose/Description Subsidize costs associated with operating an <br />homeless individuals; provide rental assistance for homeless clients <br />15211% 711wrom <br />Previous Amount <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non-Debariment, E-Verify, Iran, etc. <br />F-1 increase $ <br />n Decrease $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy Original <br />9 ❑ Judy Love <br />El <br />F] <br />