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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 7, 2019 <br />Name Andrew Netter <br />Department DCI <br />Division/Bureau Planning <br />BPW Date May 14, 2019 Phone Extension 5931 <br />IIIW. 'liA.�'JL%IVN.Gfidfll9.�WIIWIIIWWIP�T°^ " �'e-"""'"''""'""""'��IM';W�WYJI��WllIVIVIWWWV�IVIVWIVIIW'NIIW9IMIIIIM�IIMYM�MIIMIBNO�NNNIOwdYM�: VHNNN�VANNNf(1lJM'ill�lli�'i�X�XX�XX�XX�XX�XX�XX�XX�XX�XX�X�i�i'iR�Ti11M�lli <br />...0 ..�,.,.. .W...m..M ... ...—.�...,� .... ......�.....�... <br />Ieaw red Prior to Submittal to Board <br />LegalAttorney 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 E <br />Check the A <br />Agreement Amendment <br />Professional Services <br />❑ Bid Opening <br />El Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />[_p Other: <br />Company or Vendor Name <br />.... — <br />dropriate ltqM_Typ. . <br />Contract <br />esolution <br />F] Bid Award <br />U Quote Award <br />❑ C/O &PCA No <br />❑ Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />for All Submissions <br />I Proposal ........... <br />❑ Req. to Advertise <br />❑ PCA <br />lle�uired Information <br />South Bend Heritage Foundation, Inc. <br />Addendum <br />❑ Title Sheet <br />Yes Z No ❑ If Yes, Approved by <br />urcha i P sin <br />El MBE EJ WBE <br />r No 7 Yes Name of ComDan mmmm�.............. <br />Pro�y912 W. Oak St. <br />Transfer of Real_�.........�..................................................................�m.� <br />The City is transferring ownership of 912 W. Oak St. to the <br />non-profit South Bend Heritage Foundation for new <br />construction low -mod income housing through use of <br />HOME funds. <br />U Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />_.. ........ . _.._.. _ ...._......_ <br />............... ._.._ .._.�_ ...__..� eaol ed' For i haqg <br />.t,.Orders OnI <br />Amount of El Increase $ <br />❑ Decrease $ <br />