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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 14. 2019 <br />Name I <br />Department <br />R�r�� Mcy�r __... .. DCL... �........ <br />BPW Date March 21, 2019 Phone Extension 5845 <br />muuuuuuuuuuuuuuHuuuuuuuuuuuuuuuuuuuuuuuuummmmuwimmmmww�i � s¢uow�r�ur�rawar,��w ma�a�mi�����r��� riraxin�rrrrtiuer��r�uruuvo¢�ahsHw�zw�em,wwmmuoumm�miuiuim�.wuwwwwiuuwwv.�mmvwwivmvm <br />_........ w.. foired 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 <br />❑ Agreement <br />El Professional Services <br />Bid Opening <br />F"J Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />I] Other: <br />pro riate Item T lei <br />Contract <br />Resolution <br />Bid Award <br />Quote Award <br />El C/O & PCA No. <br />F1 Traffic Control <br />V for All Submissions <br />Proposal Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />l eq iredwwInformation <br />❑ PCA <br />Company or Vendor Name Indiana Housing and Community Development Authority (IHCDA) <br />Inc. <br />New Vendor [❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 MBE ❑ WBE <br />Project Name Supplemental Disaster Recovery -Owner Occupied Rehab for Lead <br />Project Number <br />Funding Source CDBG Disaster Recover Federal Funding thr <br />'.....ww ... _..m ough IHCDA <br />Account No. .eeeeeee. .. ��_..............._. �.�. <br />Amount _ __.�. ��................_�.......................................�.._Y ��..�.......................�.�...� <br />143,906.00 <br />.... .... .............. ���................................... .......... <br />Terms of Contract 8/31/18-12/31/18 extended to 12/31/19� <br />Purpose/Description Extension of original agreee ent to identify and control ....m�........._ <br />m lead hazards in <br />eligible housing units <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment E Verif , Iran, etc. <br />I e uired For Change Orders 0 ly <br />Amount of ... ...w ......... <br />Amou El Increase $ <br />❑ Decrease $ ...W..... ww <br />Previous Amount $ <br />Current Percent of Change: % ............... <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ® Pam Meyer, DCI <br />❑ ❑ <br />El ❑ <br />