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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 17.2018 <br />Name <br />Pam Meyer <br />Department <br />DCI <br />BPW Date <br />�iawar��i�m�mrivrim�rr�nreww�rvr.�i <br />December 20, 2018 <br />� iumrev�mi�;wwm®� <br />Phone Extension 5845 <br />uv�w�rorn�uuronm�m�am� � �n�rreimiimwwwwwr�w mmw rr�a�n�im� <br />uured Prior to Submittal to Board <br />Legal ® Attorney Name Sandra Kennedy <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the <br />Agreement <br />❑ Professional Services <br />E] Bid Opening <br />Quote Opening <br />Change Order No. <br />El Ease/Encroach. <br />Other: <br />iropriate Item „Type — Reqi <br />❑ Contract <br />❑ Resolution <br />El Bid Award <br />Quote Award <br />[ C/O & PCA No.. <br />❑ Traffic Control <br />d" for All Submissions <br />Proposal ❑ Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />uuired Information <br />Company or Vendor Name Cross Community CDC <br />❑ PCA <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />Project Name <br />Pilot Housing Subsidy Program - New Housing Construction <br />Project Number <br />18J034 <br />Funding Source <br />EDIT <br />Account No. <br />� 408.1001.460.39.30.........................__w� �..� �... ..�.�.�............. .� ....._�.. <br />Amount$....5.00,000.00.....�__.........��� <br />....................................................................................m.................�..m..�.......u... <br />Terms of Contract <br />......................... <br />1 _.w......................_....__.._................................................................................................aY <br />/l/19-12/31/2021 <br />Purpose/Description <br />Subsidize contractution of 7 homes in Near Northwest Target Area <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment„ E-V rif , Iran etc <br />Rewired For Chahae Orders Only <br />Amount of ❑ Increase $ <br />w <br />E] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: /o <br />New Amount <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ® Pam Meyer, DCI <br />El 1:1 <br />