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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE QUEST FORM <br />Date 9112/18 <br />Name Lary Timmer Department DC1 <br />BPW Date 9/25/18 Phone Extension 518,41 <br />Re ' 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 H <br />Agreement <br />F-1 Professional Services <br />[:] Bid Opening <br />E] Quote Opening <br />F-1 Change Order No. <br />F-1 Ease/Encroach. <br />F-I Other: Amendment <br />Contract <br />F-1 Resolution <br />F-1 Bid Award <br />F-1 Quote Award <br />[:] C/O & PCA No. <br />F-1 Traffic Control <br />Proposal <br />0 Req. to Advertise <br />FO-M <br />Company or Vendor Name Near Northwest Neighborhood, Inc. <br />New Vendor El Yes M No El If Yes, Approved by Purchasing <br />MBEANBE Contractor F-1 MBE r_1 WBE <br />MBE/VVBE Contractor Requested Z No F-1 Yes Name of Company <br />Project Name Acquisition / Rehabilitation Activity <br />Project Number 18_JC_ <br />Funding Source Community Development Block Grant CDBG) <br />Account No, 212.1001,460.3930 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Previous Amount <br />F-1 Title Sheet <br />$165,000 <br />1/01/18 — 12/31/20 <br />Acquire and rehab the property at 750 C tta e Grove for resale to <br />low -mod income buyer <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />increase $ <br />Decrease $ <br />Current Percent of Change: — % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />X <br />Copy <br />Original <br />M <br />Judy Love <br />F-1 <br />El <br />El <br />El <br />