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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />November 26, 2019 <br />Pam M <br />Department DCI <br />BPW Date December 10, 2019 Phone Extension 5845 <br />o-�auwsu�ru���iaur�mmmouuuuuuuuuuuuuuuuuuuuuuuuuuuuuumarm.mw�ruAsrvxrr��,�,,,,,,,,,,,,,,�,,�»„�„��mm��iHixo�ruHuxoioioioio�uHuuuuuuuuuuuuuuuuununmmm�urrv�;rea�nmm�m�aa�e ..... ... �iowr�uwoumoiooimom�mm�mmr� mriµ��r�aa�srwr�www�:rr�mm�w��—��.�...�..��.� �arrr�urur�naaas� <br />Re uired Prior to Submittal to Board <br />_��.....� .....�_. Legal . � .,._-....�_....�w,._w.m.�.��.._.......����..�_ ..... ..�. <br />Attorney Name Sandra Kennedy <br />Controller ❑' Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing [❑ <br />Check th <br />_.._ e <br />Agreement <br />El Professional Services <br />[] Bid Opening <br />Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />El Other: <br />Company or Vendor Name <br />Inc. <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />e Item Tvne --- <br />LJ Contract <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑' C/O &PCA No. <br />0 Traffic Control <br />)r All Submissions <br />........ ____................. <br />. <br />Proposal Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ PCA <br />lu,ired Information <br />Indiana Housing and Community Development Authority (IHCDA) <br />Yes N No If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />Supplemental Disaster Recovery -Owner Occupied Rehab for Lead <br />BG-Disaster Recovery Federal Funding through IHCDA <br />$ 143,906.00 <br />1 1......2.02....t.°6/3/2020 0............................................. ...................................................................... <br />.....w..........._ _ <br />Extension of original agreeement to identify and control lead hazards in <br />eligible housing units <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, mn <br />ollusiontl on-Discriination, Non Debarment„ E-Vef Iran <br />F�equired For Change Orders Only <br />Amount of Increase $ <br />❑] Decrease $ <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />® ® Pam <br />❑ E] <br />Dispersal After Approval <br />, DCI <br />