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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/12/18 <br />Name Lory Timmer Department DCI <br />BPW Date 9/25/18 Phone Extension 5841 <br />.................. -- .... .. . ....... <br />Required ,Prior �� aubrrtlttal 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 />[:] Agreement <br />Z Contract L] Proposal Ll Addendum <br />F-1 Professional Services <br />F-1 Resolution <br />[:1 Bid Opening <br />0 Bid Award El Req. to Advertise El Title Sheet <br />E] Quote Opening <br />El Quote Award <br />F-1 Change Order No. <br />F-1 C/O & PCA No. ❑ PCA <br />n Ease/Encroach,. <br />F-1 Traffic Control <br />F-1 Other: Amendment <br />Company or Vendor Name REAL Services, Inc <br />New Vendor <br />0 Yes Z No F-1 If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />F-1 MBE [:] WBE <br />MBEANBE Contractor <br />Requested Z No F Yes Name of Company <br />Project Name <br />Aging: in Place Program <br />Project Number <br />18-JC-31 <br />Funding Source, <br />Community Development Block Grant (CDBG) <br />Account No. <br />212.1001.460.39.30 <br />Amount <br />$100,000 <br />Terms of Contract <br />1/01/18 - 12/31/1 <br />Purpose/Description <br />Provide essential home repairs for elderly, low -mod income <br />homeowners <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of F-1 <br />increase $ <br />[:] <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />z F-1 <br />Judy Love <br />F-1 1:01 <br />El 1-1 <br />