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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/14/18 <br />Name Lory Timmer Department DCI <br />BPW Date 9/2,5/18 Phone Extension 5841 <br />Required Prior to Submittal to Board <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 z <br />H Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />[_1 Quote Opening <br />r_1 Change Order No,. <br />E] Ease/Encroach, <br />F-1 Other: Amendment <br />Contract <br />Resolution <br />Bid Award <br />F-1 Quote Award <br />El C/O & PCA No. <br />F] Traffic ControI <br />Proposal LJ Addendum <br />❑ Req. to Advertise El Title Sheet <br />IN . a <br />Company or Vendor Name The Center for the Homeless, Inc, <br />New Vendor F-1 Yes Z No E] If Yes, Approved by Purchasing <br />MBEMBE Contractor F-1 MBE F-1 WBE <br />MBEMBE Contractor Requested Z No F1 Yes Name ofCompany <br />_ <br />Project Name Permanent Supportive Housing Scattered Site Operations <br />Project Number 18-JC-09 <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of M <br />El <br />Community Development Block Grant (CDBG) <br />212.1001.460.39.30 <br />$129,835 <br />10/01/18 — 12/31/19 <br />Support permanent supportive housing operations / case <br />management for persons experiencing homelessness <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 />Copy Original <br />M 0 Judy Love <br />1-1 F-1 <br />1:1 El <br />Dispersal After Approval <br />