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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 17, 2019 <br />Name Andrew Netter <br />Department DCI <br />Division/Bureau Planning <br />BPW Date 09/24/2019 Phone Extension 5931 <br />.:.,vem�wumaimm �����warwrc;iv�u�n r�n�rwscwiowA r�,�r. vrura�mvrsw;mvra��a�— �;,�rvtw,�,���u�u�u�u�uuwuaw�ww�w:r ma�mummm.mwwwwumi�mr��r�urew��7�mr,�i,��..��aiwwmamoomu��:m�.rin �s <br />_ITIT.. ... ...._.—... <br />�, ... ........ .._,., _._.........w_,._._ ... ._ _ ._,,,...m......_._...... <br />Board <br />Rem ulred Prior to Submittal to— mmIT _ <br />Legal ® <br />._ ....... <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 />Che ..� _ <br />..—w k the Ap r ro a Item TypIT ._R�,rq for Al/ Submissions <br />Agreement Amendment <br />LJ <br />ITIT m ITITIT <br />Contract E] Proposal [�Addendum <br />E] Professional Services <br />❑ <br />Resolution <br />❑' <br />Bid Opening]' <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />Quote Award <br />El Change Order No. <br />C/O & PCA No. ❑ PCA <br />0 Ease/Encroach. <br />❑ <br />Traffic Control: <br />® Other: Property Donation Agreement / Resolution <br />Accept19 the transfer of crop qy to the Civil City�mw _ <br />uired Information <br />Company or Vendor Name <br />Habitat for Humanity of St Jose h Coun , IInc <br />..... �w <br />El Yes Z No If Yes, Approved by <br />New Vendor <br />rchasin ._ <br />MBE/WBE Contractor <br />� <br />MBE <br />�,��..- <br />WBE <br />MBE/WBE Contractor Requested <br />q <br />❑ <br />No ❑Yes <br />­ of Comp ...._ <br />Name an <br />Protect Name <br />Property Donation — 1251 W. Colfax <br />Project Number <br />..... .. �.. ..... _.... _...,,............................w� __,... <br />Funding Source <br />018-1050-460 36.01 <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description Habitat for Humanitywishes to donate ............ <br />5 mm .......� <br />a vacant lot at 1251 W. <br />Colfax to the City. The City offers to cover all transfer and <br />recording fees a <br />or'_ <br />transaction. <br />__._-Re.quire_ Contractor's Certification Forms <br />_ <br />Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />._....._ ..... wired For an Orders O mm _ ..._.� . _.....w <br />..._.w ........ _ <br />Amount of Decrease <br />