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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 3, 2019 <br />e Department DCI <br />Name A.,lkeyna Aldri......d ......._............................._....... <br />BPW Date December 10, 2019 Phone Extension 5896 <br />alrtlrtrt�M/M.,rc�IWVIVIVIIW114W!WIW!WIW.WW'WWIIVI4�. N'�81mImIIIVIIIIVIIIIII'WJ'W%M'f� �iry�Wq(!(,S�ppAN�—?. 6M �' �gy'�ry„y� INiIAY/tlfl�;NrPogq�p�®1VIry,�M.9NOMVNIVNMflIr� '� tlIY?�IWMA�/i/�Wp!�,�IIMIWIIVYWLL�1Wl" 4x"—^^!�/(��g <br />.,;;_.�._,,,,,�._ ��Rigred Prior to Submittal to Board _w m _wwITm„ w <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 />Bid Opening <br />Quote Opening <br />0 Change Order No. <br />El Ease/E croach, <br />RI Otherlo <br />L Contract <br />F Resolution <br />El Bid Award <br />El Quote Award <br />C/O & PCA No. <br />❑ Traffic Control <br />)r All Sul <br />Proposal <br />❑ Req. to Advertise <br />on . <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Company or Vendor Name South Bend Heritage <br />Foundation <br />New Vendor Yes ® No [] If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />Project Name Charles Martin Center Lease <br />Project Number <br />Funding Source D........................weee..........................rw <br />CI Admin <br />Account No. 211-1001- -460.31-06 �.. m... <br />Amount (up to)_ <br />Terms of Contract December 1, 2019- December 31 2022 (Commencement Date December <br />Le 2019 <br />Purpose/Descriptionµ rovide s ace for" ��... —m... <br />Lease top p neighborhood -based AmeriCorps <br />Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of El Increase $ <br />J Decrease $ <br />