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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 6, 2016 <br />Name <br />Pam Meyer <br />Department <br />Community Investment <br />BPW Date <br />July 26, 2016 <br />Phone Extension <br />5845 <br />r _ Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name Michael Schmidt, Andrea Huntington, Ben <br />Dougherty <br />Controller ® <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement <br />❑ Contract ❑ Proposal ®Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />F1 <br />Other: <br />ny or Vendor Name Urban Enterprise Association of South Bend, Inc. <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />J Yes X No ❑ If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />V&A Property Repair Matching Grant Program <br />1001.460.39.30 <br />$ 96,500.00 total; addendum adds $30,000 to original $66,500 <br />October 1, 2014-December 31, 2017 <br />Provides matching grants to homeowners and landlord owners to repair a <br />V&A property and live in or rent for a minimum of 3 years <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Chanqe 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 <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />Pam Meyer, DCI <br />Andrea Huntington, Legal <br />