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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />8/03/16 <br />Timmer <br />Department DCI <br />BPW Date 8/23/16 Phone Extension 5841 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® 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 />❑ <br />Bid Opening <br />Quote Opening <br />❑ Bid Award ❑ Re <br />El Quote Award q to Advertise ❑Title Sheet <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />❑ <br />Other: Amendment <br />Required Information <br />Company or Vendor Name Department of Code Enforcement <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEM/BE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name Vacant & Abandoned Building Demolition Program <br />Project Number 16-JC-14 <br />Funding Source Community Development Block Grant (CDBG) <br />Account No. 212.1001.460.39.30 <br />Amount $ 150,000 <br />Terms of Contract 1/01/16 — 12/31/17 <br />Purpose/Description Fund demolition of vacant & abandoned properties in low -moderate <br />income neighborhoods <br />® Required Contractor's Certification Form Attached (Non- <br />('ollusion, 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 />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />Love <br />Dispersal After Approval - <br />