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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 1, 2024 <br />Name Joseph Molnar <br />Department <br />Division/Bureau <br />DCI <br />Planning <br />BPW Date July 9` 2024 Phone Extension 6052 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: Danielle Campbell Weiss <br />Controller ❑ <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement Amendment ❑ Contract ❑ Proposal ❑ Addendum <br />F1 Professional Services n Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />® Other: Transfer Agreement <br />Required Information <br />Company or Vendor Name Northeast Neighborhood Revitalization Organization Inc <br />❑ Yes ® No ❑ If Yes, Approved by <br />New Vendor Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Transfer of Real Property 839 South Bend Ave <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description The City is transferring ownership of 839 South Bend Ave to <br />the Northeast Neighborhood Revitalization Organization for <br />the use of the space as a small pocket park maintained by <br />the organization. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required 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 />Dispersal After Approval <br />Copy Original <br />® ❑ Andrew Netter <br />