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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 15, 2019 <br />___...... Department DCI <br />Name Andrew Netter <br />Division/Bureau Planning�� <br />BPW Date 07/23/2019 Phone Extension 5931 <br />nmx¢i^rvanrwu^-.,ra -,a�zumw✓a�u, �wmrrvsawww,ux r�,,A,.,.,,,,y,y,mmwrcaareanAiMmiHiHUHuimrrmrar, m,rax,,,...-. M. awe , wir.mmeewvr zrsnrrx� u..owoio.�ws�mrammm¢w;s:.-.x-s�uaeavr»mamm <br />Legal <br />Attorney Name: Clara McDaniels <br />Controller ❑ <br />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 <br />......._ ..... Check therr_ariate Item Typeset ire for All Submissions <br />A reement Amendment <br />g <br />_...... ���ITITITITITm <br />� Contract �I Proposal El Addendum <br />El <br />Professional Services <br />❑ Resolution <br />Bid Opening <br />❑ Bid Award ® Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />❑ Quote Award <br />Change Order No. <br />C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ <br />Traffic Control: <br />Other: <br />_._ <br />_...... _._....._. _ _._ _ ..r <br />Rqquired Information <br />Company or Vendor Name <br />Donna Adkins <br />j❑ Yes[-] No If Yes, Approvedby <br />New Vendor <br />Purchasing <br />MBE/WBE Contractor <br />El <br />MBE <br />❑ WBE <br />MBE/WBE Contractor Requested <br />q <br />No ❑Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />._._.. <br />Account No. <br />m. .....w�_... <br />408-10 50-460-31.25 <br />Amount <br />mm._. _- ........ <br />...... __ _�..�... .... ........__..... <br />$1,350 <br />Terms of Contract <br />Purpose/Description <br />_ - <br />Request to advertise the disposition of 1007 W. Oak, <br />k, South <br />Bend, IN 46616. The City was petitioned by the adjacent <br />p gp#gy owner, Donna Adkins, <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />__-Rired For ChengwwOrders <br />F] Increase $ <br />Amount of <br />Decrease <br />Previous Amount _......m_. _ __ m...... �..... <br />