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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/12/18 <br />Name Lary Timmer Department <br />M <br />BPW Date 9/25/18 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 />Agreement <br />E] Professional Services <br />F-1 Bid Opening <br />El Quote Opening <br />E] Change Order No. <br />01 Ease/Encroach. <br />F-1 Other: Amendment <br />Contract <br />F-1 Resolution <br />F-1 Bid Award <br />0 Quote Award <br />F1 C/O <br />F-1 Traffic Control <br />9= <br />E] Req. to Advertise <br />Company or Vendor Name South Bend Human Rights Commission <br />New Vendor E] Yes Z No E] If Yes, Approved by Purchasing <br />MBEIWBE Contractor F-1 MBE F] WBE <br />MBE/VVBE Contractor Requested Z No E] Yes Name of Company <br />Project Name Affirmative Fair Housing Activities <br />Project Number 18-JC-89 - <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of F-1 <br />F1 <br />Community Development Block Grant (CDBG) <br />212.1 001 A60,39.30 <br />$10,000 <br />1/01/18 - 12/31/18 <br />❑ Title Sheet <br />Investigate fair housing complaints; provide educational materials <br />and training related to fair housing <br />E Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E,-Verifv, Iran, etc. <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />0 <br />El Judy Love <br />El <br />n <br />0 <br />El <br />Dispersal After Approval <br />