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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 1, 2024 Department DCI <br />Name Joseph Molnar Division/Bureau Planning <br />BPW Date July 9th 2024 Phone Extension 6052 <br /> <br />Required Prior to Submittal to Board 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 /> Professional Services 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 />New Vendor <br /> Yes No If Yes, Approved by <br />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 <br /> <br />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 /> <br /> <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 <br /> <br />Increase <br />Decrease <br />$ <br />$ <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 /> <br />