HomeMy WebLinkAboutMemorandum of Understanding - United Way of St Joseph County INc - Neighborhood Programs and Services1316 COUNTY —CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND_ INDIANA 46601-1930
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARDU LC WORKS
February 26, 2019
Jeffrey Cooper
United Way of St. Joseph County, Inc.
3517 Jefferson Blvd.
South Bend, IN 46615
RE: Memorandum of Understanding
Dear Mr. Cooper:
PHONE 574/235-9251
FAx 574/235-9171
The Board of Public Works, at its meeting held on February 26, 2019, approved the above
referenced MOU for neighborhood programs and services in the amount not to exceed
$25,000.
Enclosed please find a copy of the agreement for your records.
If you have any further questions regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
Linda M. Martin, Clerk
Enclosure
GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK LAURA O'SULLIVAN THERESE J. DORAU
V Terr
@ 86
INTER -OFFICE MEMORANDUM
Department of Community Investment
City of South Bend 227 W Jefferson Blvd
TO: Board of Public Works, Linda Martin
CC: Sandra Kennedy
FROM: Alkeyna Aldridge
SUBJECT: 2019 United Way AmeriCorps Agreement
DATE: February 18, 2019
Dear Clerk and Members of the Board,
We are submitting for review and approval at the February 26th meeting an agreement between
the City of South Bend and the United Way to support the Engagement & Economic
Empowerment team's community outreach efforts. The funds will enable the hiring of two (2)
full-time AmeriCorps volunteers to support the community engagement efforts of the team's
Engagement Specialist.
In the spirit of the city values of inclusion, empowerment, and accountability we believe it is the
responsibility of the municipality to build capacity and sustainability for a robust neighborhood
association system as means.to effectively communicate with and respond to residents. This
agreement will allow our team the additional capacity necessary to engage in direct, grassroots
relationship building within our neighborhoods. Thank you for your consideration and should
feel free to contact me directly at paldri��' , sou, ���s�n irk gpv should you have any questions or
concerns.
i Economic Empowerment
Ll40 T * � 1
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i
United Way
of St. Joseph County
2019 Program Year
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MEMORANDUM OF UNDERSTANDING
I. Purpose
A. This document defines the responsibilities of the United Way of St. Joseph County (hereinafter referred to
as "Lead Agency") and the City of South Bend, acting by and through its Board of Public Works, for the
benefit of the Department of Community Investment, for the assignment of AmeriCorps Member(s) to
perform services to address neighborhood organization capacity building support as specified in the
AmeriCorps grant which services and programs are particularly described at "Exhibit A".
II. Term of Memorandum of Understanding
This Agreement shall become effective upon execution by both parties and shall terminate on August 31, 2019.
Ill. Duties of the Lead Agency
A. Coordinate the recruitment of AmeriCorps members and assure all members enrolled meet eligibility
requirements.
B. Provide technical assistance to Service Site in developing work plans and Position Descriptions for each
assignment.
C. Assist in the provision of site -specific training and in-service training.
D. Assign AmeriCorps members to a Service Site, matching interests and skills with tasks to be accomplished in
the focus areas of early childhood education and financial literacy.
E. Provide administrative support to AmeriCorps members and Service Site.
F. Conduct monitoring activities and site visits with the Service Site to maximize understanding and compliance.
G. Retain full responsibility for the management and fiscal control of the project.
H. Facilitate all disciplinary proceedings involving AmeriCorps members.
I. Transfer an AmeriCorps member from one placement to another, if needed, consistent with program and
Service Site needs.
J. Release members from service for cause or compelling personal circumstance should the need arise.
IV. Duties of the Service Site
A. Remit the agreed cost share amount of 14,990 per full-time member, $2,495 per half-time member, $1,871
per reduced half-time member, and 750 per minimum time member to the Lead Agency within 30 days of
enrolling your member.
B. Take responsibility for the recruitment and retention of members and the promotion of the program.
C. Maintain relationship with members. Service Site Supervisors understand that training and supervision of
members will be necessary.
D. Take part in training provided by the Lead Agency prior to receiving a member. Services Site Supervisors
must attend 80% of mandatory Service Site Supervisor trainings.
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E. Provide site specific training and orientation including guidelines, regulations, and policies of the site
F. Service Sites will not engage in or encourage members to engage in prohibited activities..
G. Provide Position Descriptions for AmeriCorps member(s) utilizing the efforts of such members exclusively to
pursue objectives of the AmeriCorps program. The Position Description should be submitted prior to the
assignment of the AmeriCorps members.
H. In developing these Position Descriptions, Service Site agrees that no AmeriCorps member assigned under
this Agreement shall participate in or use funds from Serve Indiana for activities that:
a. Are illegal under local, state or federal law;
b. Pose a significant safety risk to the AmeriCorps member(s) or others;
c, Prepare any part of a grant proposal or performing other fundraising functions to help the program
achieve its match requirement, or to pay the program's general operating expenses;
d. Displace or replace efforts conducted by Host Site staff;
e. Attempt to influence legislation;
f. Organize or participate in protests, petitions, boycotts or strikes;
g. Assist, promote or deter union organizing;
h. Impair existing contracts for services or collective bargaining agreements;
i. Participate in or endorse events or activities that are likely to include advocacy for or against political
parties, political platforms, political candidates, proposed legislation, or elected officials;
j. Engage in religious instruction, conduct worship services, provide instruction as part of a program that
includes mandatory religious instruction or worship, constructing or operating facilities devoted to religious
instruction or worship, maintaining facilities primarily or inherently devoted to religious instruction or
worship, or engaging in any form of religious proselytizing;
k. Provide a direct benefit to —
• a for -profit entity;
• a labor union;
• a partisan political organization;
• A nonprofit organization that fails to comply with the restrictions contained in
section 501(c)(3) of the Internal Revenue Code of 1986 except that nothing in this section
shall be construed to prevent participants from engaging in advocacy activities
undertaken at their own initiative; or
• an organization engaged in religious activities unless Corporation for National
& Community Service assistance is not used to support those religious activities;
I. Conduct a voter registration drive or using Corporation funds to conduct a voter registration drive;
m. Provide abortion services or referrals for receipt of such services;
n. Such other activities as the Corporation for National & Community Service may prohibit.
o. Engage in the above activities [a — n] directly or indirectly by recruiting, training, or managing others for
the primary purpose of engaging in one of the activities listed above. Individuals may exercise their rights
as private citizens and may participate in the activities listed above on their initiative, on non-AmeriCorps
time, and Individuals should not wear the AmeriCorps logo while doing so.
I. Provide day-to-day supervision of the activities of the AmeriCorps members.
J. Must take every action to ensure that AmeriCorps Members are safe from violence and accidents.
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K. Service Sites understand that training is an integral component of the AmeriCorps service experience and will
make every effort to ensure that members are available and can participate in training, national days of
service, AmeriCorps week, and other group activities. Prior notice will be given to all Service Site
Supervisors.
L. Provide cross training to AmeriCorps Members at the same site to further enhance overall member
performance.
M. Provide resources for transportation to members as relevant and needed.
N. Provide materials and supplies related to the performance of assignments, an adequate working space, and
Internet access including e-mail to permit AmeriCorps members to perform assigned duties.
O. Cooperate with the Lead Agency in implementing the individual career development plan for each
AmeriCorps member.
P. Assist in the mid -year and end -of term performance evaluation of assigned members..
Q. Notify the Lead Agency immediately regarding unscheduled changes of status and conditions of AmeriCorps
members, such as arrests, hospitalizations, and absence without leave.
R. Ensure that all documentation including fiscal records, timesheets, monthly reports/in-kind forms and other
documentation are completed and submitted to the Lead Agency by designated deadlines.
S. Service Site Supervisors will approve timesheets within 5 business days of the last day of timesheet period.
Site Supervisors will submit in -kind reports within 5 business days of the last day of the timesheet period.
T. Comply with monitoring and site visit activities coordinated by the Lead Agency.
U. Maintain fiscal and programmatic records and accounts, including reports and investigations concerning
matters involving AmeriCorps members and the program. Provide such records upon request to the Lead
Agency, Serve Indiana, or Corporation for National & Community Service for examination. The Service Site
agrees to retain such records for a period of three years after completion or termination of the program, or
longer if required for audit, administrative proceedings and/or litigation purposes upon notification received
from the Lead Agency, Serve Indiana or the Corporation for National & Community Service.
V. Allow AmeriCorps members to participate in local emergency disaster relief efforts, if needed..
W. Allow AmeriCorps members and make service site supervisors available, whenever possible, to participate in
bi-weekly trainings.
X. Allow AmeriCorps members to participate in Days of Service, such as Martin Luther King Holiday, National
Volunteer Week, Global Youth Service Day, Make a Difference Day, should activities be organized in the
communities where the members are in service.
Y. Avoid projects resulting in the identification of the AmeriCorps program with partisan or non -partisan political
activities, including voter registration activities, or providing voter transportation to the polls.
Z. Failure to comply with the Service Site responsibilities will result in relocation of the assigned member(s) to
another site or program with no reimbursement of the amount specified in this Memorandum of
Understanding.
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V. Joint Responsibilities
The parties to this Memorandum of Understanding agree to the following.
A. Make every reasonable effort to ensure that the health and safety of AmeriCorps members are protected during
the performance of their duties.
B. Not assign or require AmeriCorps members to perform duties which would jeopardize their safety or cause them
to sustain injuries.
C. Avoid placing related persons in supervisor-supervisee relationships or other roles that could lead to a conflict of
interest.
D. Both parties agree to strive to assure the full involvement of all interested and eligible parties, including those with
a disability.
E. Both parties agree to use the AmeriCorps Indiana logo on their website and in other marketing efforts describing
or promoting the AmeriCorps program; to display AmeriCorps signage upon request; to use the words "an
AmeriCorps program supported by Serve Indiana and the Corporation for National & Community Service" in
describing the AmeriCorps program; to provide training to AmeriCorps members on their part in AmeriCorps and
national service; and to strongly encourage AmeriCorps members to state that they are AmeriCorps members
during presentations and speaking opportunities.
Vl. Drug Free Workplace Act
A. Service sites must be drug -free workplace and have notices clearly posted where Members can see them.
B. In accordance with the Drug Free Workplace Act, the unlawful manufacture, distribution, dispensation,
possession, or use of a controlled substance is prohibited by the program.
C. Alcohol and drug abuse adversely affects health, service performance, creates dangerous situations and serves
to undermine the community's confidence in the AmeriCorps program. The AmeriCorps Program prohibits drug
or alcohol abuse on the part of its members.
D. The Lead Agency or Service Site may require members to submit to drug testing as a condition of selection or
when there is reasonable suspicion of drug use.
E. If an AmeriCorps member is arrested for or convicted of a drug offense, the member must notify her/his
supervisor and the program director in writing within five days.
F. The program will take appropriate action against an AmeriCorps member including suspension and referral to a
drug rehabilitation program, or release for cause consistent with the Corporation for National & Community
Service rules on termination and suspension of service.
VII. Equal Opportunity
A. The parties agree to abide by federal laws and Corporation for National and Community Service (CNCS) policy on
Equal Opportunity. An environment free of discrimination for all AmeriCorps members will be provided by the
parties. Recognizing that our society is strengthened by the diversity of its citizens, CNCS's policy is to ensure
mutual respect for all differences among us.
B. The parties agree that no person with responsibilities in the operation of the project shall harass or discriminate
against any AmeriCorps Member, or member of the staff of, or beneficiary of the project, with respect to any
aspect of the project on the basis of race, religion, color, national origin, sex, age, disability, or political affiliation.
Harassment includes unwelcome verbal, physical or graphic conduct and has the purpose or effect of
unreasonably interfering with work or service performance or creating an intimidating, hostile or offensive work or
service environment.
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VIII. Amendments
This Memorandum of Understanding may be amended at any time by written consent of authorized
representatives of the Lead Agency and Service Site.
IX. Termination
A. This Memorandum of Understanding may be terminated by agreement of the parties if written notice is
received 30 days prior to the termination date, however no refunds will be issued by United Way once a
Member begins service at a site.
B. Termination of the Sub -grant Agreement between the Lead Agency and the Serve Indiana will result in the
termination of this Memorandum of Understanding, aside for provisions relating to record keeping and
retention.
Authorization
The authorized representatives of the Lead Agency and Service Site hereby acknowledge by their signatures that
they have read, understand, and agree to all terms and conditions of this Memorandum of Understanding.
SIGNATURE PAGE FOLLOWS
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IN WITNESS THEREOF, the parties have duly executed this Memorandum of Understanding hereto and each
party acknowledges receipt from the other party of a duly executed copy of the Memorandum of Understanding.
SERVICE SITE
CITY OF SOUTH BEND, INDIANA
BY AND THROUGH ITS
BOARD OF PUBLIC WORKS
FOR THE BENEFIT OF ITS
DEPARTMENT OF COMMUNITY INVESTMENT
Date: February 26, 2019
Gary A. Gilot, President
e' se J, DotauA......Me er
`S0"nna Fritzberg, Member
Ehz th A. Maradlk„ M er
t
_... ........
aura O'Sullivan, Member
ATTEST:
Linda
k
M. Martin
LEAD AGENCY
Authorized Legal Representative — SIGNATURE Date
Authorized Legal Representative - PRINT NAME
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Exhibit A
2019 AmeriCorps Member Scope of Work
The United Way AmeriCorps volunteers will work to build the capacity of neighborhood organizations through
improved communications, grassroots organizing and direct resident technical assistance to empower residents
with resources and skills necessary to lead change and improve neighborhood quality of life.
1. Collaborative Engagement Calendar with the Neighborhood Resources Connection ("NRC")
2. Engagement Team information sharing and listening sessions with NAs
3. Technical Assistance for Neighborhood Associations ("NA") by Engagement Team
a. Gathering list of NA initiatives and goals for 2019
b. Will meet with NA presidents throughout the year to offer additional boots on the ground and
organizing capacity
4. Direct Resident Engagement
a. Working with city populations as identified by the City Administration and Community
Investment Leadership
i. Public Narrative Training
1. Teaching NAs and community stakeholders a new technique for storytelling and
community organizing
ii. Empowerment Fairs
1. Working Higher Ed Institutions to bring City Resources into Neighborhoods
iii. Empowerment Summit co -sponsored by the NRC
b. Census 2020
i. Literature Drops around the Census related opportunities in the area
ii. Vetting old list of stakeholder organizations throughout the community
iii. Support of Community Events and NA event during 2nd and 3rd quarters of 2019
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Internal Revenue Service
P.O. Box 2508
Cincinnati, OH 45201
Date: NOV 18 2,015
UNITED WAY OF ST JOSEPH COUNTY INC
3517 E JEFFERSON BLVD
SOUTH BEND IN 46615
Dear Sir or Madam:
Department of the Treasury
Employer Identification Number:
35-1063368
Person to Contact - ID Number:
Jacob McDonald - 0203230
-Contact Telephone Number:
877-829-5500 Toll -Free
Form 990 Required:
Yes
In your letter dated October 19, 2015, you requested classification as a public charity
described in sections 509(a)(1) and 170(b)(1)(A)(vi) of the Internal 'Revenue Code.
In our letter dated June 1963, we determined that you were exempt under section
501(d)(3) of the Code. We further determined that you weren't a private foundation and
you, were classified as a public charity described In section 609(a)(2) of the Code,
Based on the information you provided, we determined you meet the requirements for
Classification as a public charity described in sections 509(a)(1) and 170(b)(1)(A)(vi) of
the Code.
Accordingly, we have updated your public charity status in our records as you requested.
Since your exempt status wasn't under consideration, you continue to be classified as an
organization exempt from federal income tax under section 501(6)(3) of the Code.
Grantors and contributors may generally rely on this determination of your foundation
status unless the internal Revenue Service publishes notice that you are no longer
recognized as tax exempt car olassified as a public charity in the Internal Revenue
Bulletin. However, if a grantor or contributor takes any action, or Falls to take any action,
which causes you to lose your exempt status or causes you to be reclassified as a
private foundation, that party cannot rely on this determination. Furthermore, a
contributor or grantor who knows that the Internal Revenue Service has notified you of
any change in your exempt status or foundation status cannot rely on this determination.
For important information about your responsibilities as a tax-exempt organization, go to
www_irs.gov/charities, Enter "4221-PC"' in the search bar to view Publication 4221-PC,
Compliance Guide for,501(c)(3) Public Charities, which describes your recordkeeping,
reporting, and disclosure regUirernents,
Because this letter could help resolve any questions about your exempt status and/or
foundation status, you should keep it with your permanent records.
Letter4426 (Rev. 5-2011)
Catalog Number 52256W
Page Z
UNITED WAY OF ST JOSEPH COUNTY INC
35.1063368
If you have any questions, please contact the person whose name and telephone
number are shown in the heading of this letter.
Sincerely,
jetfr y 1. Cooper
Director, Exempt Organizations
Rulings and Agreements
Letter 4426 (Rev. 5 2011)
Catalog NUMber 522b6W
Entity Type: Domestic Nonprofit Corporation Business Status: Active
Creation Date: 09/19/1961 Inactive Date:
Principal Office Address: 3517 E. Jefferson Blvd., SOUTH BE, IN, Expiration Date: Perpetual
46615, USA
Jurisdiction of Formation: Indiana Business Entity Report Due 09/30/2020
Date:
Years Due:
.. �... u, ..
Title
Name
Address
Vice President
Mark Ilerriman
3517 E. Jefferson Blvd., South Bend, IN, 46615, USA
Treasurer
Leslie Yates
3517 E. Jefferson Blvd., South Bend, IN, 46615, USA
President
Randolph Rompola
3517 E. Jefferson Blvd, South Bend, IN, 46615, USA
CEO
Laura Jensen
3517 E. JEFFERSON BLVD., South Bend, IN, 46615, USA
Type: Individual
Name: Laura Jensen
Address: 3517 E. Jefferson Blvd., South Bend, IN, 46615, USA
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT,
CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY
VERIFICATION, NONDISCRIMINATION COMMITMENT AND CERTIFICATION OF USE
OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF )
SS:
COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that:
I. Contractor has not, nor has any other member, representative, or agent of the firm,
company, corporation or partnership represented by him, entered into any combination, collusion
or agreement with any person relative to the price to be bid by anyone at such letting not to
prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid
is made without reference to any other bid and without any agreement, understanding or
combination with any other person in reference to such bidding. Contractor further says that no
person or persons, firms, or corporation has, have or will receive directly or indirectly, any
rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its
principals are presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any Federal department or agency;
and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency or
instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from
time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is
engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty million
dollars ($20,000,000) or more in value in the energy sector of Iran; or
ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty
million dollars ($20,000,000) or more in credit to another person for forty-five (45)
days or more, if that person will (i) use the credit to provides goods and services in
Non -Collusion Non-Debannent Affidavit Non Iran Form 2016
the energy sector in Iran; and (ii) at the time the financial institution extends credit, is
a person identified on list published by the Indiana Department of Administration.
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the Contractor subsequently learns is an
unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility
status of all of Contractor's newly hired employees through the E-Verify Program as defined by
I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify
Program is included and attached as part of this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public
contract to certify that the subcontractors do not knowingly employ or contract with an
unauthorized alien, nor retain any employee or contract with a person that the subcontractor
subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is
participating in the E-Verify Program. The Contractor agrees to maintain this certification
throughout the term of the contract with the City of South Bend, and understands that the City
may terminate the contract for default if the Contractor fails to cure a breach of this provision no
later than thirty (30) days after being notified by the City.
6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by
the City of South Bend through its agencies, boards, or commissions shall not discriminate
against any employee or applicant for employment in the performance of a City contract with
respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or
indirectly related to employment because of race, sex, religion, color, national origin, ancestry,
age, gender expression, gender identity, sexual orientation or disability that does not affect that
person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials,
or any combination of the foregoing including, but not limited to, public works contracts
awarded under public bidding laws or other contracts in which public bids are not required by
law, the City, its agencies, boards, or commissions may consider the Contractor's good faith
efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority
Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining
the lowest, responsible, responsive bidder.
In no event shall persons or entities seeking the award of a City contract be required to award a
subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said
WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board
shall prohibit that person or entity from being awarded a City contract for a period of one (1)
year from the date of such determination, and such determination may also be grounds for
terminating the contact for which the discriminatory practice or noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination commitment
shall be made a part of any contract which it may henceforth enter into with the City of South
Bend, Indiana or any of its agencies, boards or commissions.
Nan -Collusion Non -Debarment Affidavit Non Iran Form 2016
Contractor agrees not to discriminate against or intimidate any employee or applicant for
employment in the performance of this contract with privileges of employment, or any matter
directly or indirectly related to employment, because of race, religion, color, sex, gender
expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of
this provision may be regarded as material breach of contract.
1, the undersigned bidder or agent as contractor on a public works project, understand my
statutory obligations to the use of steel products or foundry products made in the United States
(I.C. 5-16-5-1). I hereby certify that I and all subcontractors employed by me for this project will
use steel products or foundry products made in the United States on this project if awarded. I
understand I have an affirmative duty to notify the City in my bid that my proposal does not
include the use of steel products or foundry products made in the United States. I understand it is
my sole obligation and responsibility to provide a justification to the City, subject to review and
approval, why the cost of United States made steel or foundry products is unreasonable. Prior to
award and upon submission of bid which does not use steel products or foundry products made
in the United States, the City, through its director of public works, shall make a determination if
the price of United States made steel or foundry is unreasonable. I understand that violations
hereunder may result in forfeiture of contractual payments.
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for
public works are true and correct.
Dated this _� ' _-__ day o ", 20n
t�
LORY L. TIMMER
CountY
s° roan
t Joseph
pSoptambarr'
My CommIsslon Expilas
,
Printed Name and Title
Subscribed and sworn to before me this play of
My Commission Expires , Pam.
1�lotctt'v
County of Residence
Non -Collusion Non -Debarment Af5davit Non Iran Form 2016
_ , a f kqb
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date February 18. 2019
Department Community
Name Alkeyna Aldridge Investment
BPW Date February 26 2019 NNYm Phone Extension 5896
_......._ _......... ...... ............
.._
Required Prior to Submittal to Board
Department ...111,
... ..... .....
....w
Attorney:
Sandra
Legal ® Kennedy
BPW Attorney:
Clara
McDaniels
Controller review is required for all Contracts $5,000.00 or more
Controller ® and greater than one year in length per the City Purchasing
Policy
Purchasing
at Item Ty
pe ..
.M__..... m... Check the App'ro..._w_P ' "�pe .�1R'eclulrcd for All Srnls,ioo; .
ZA Agreement �] Contract Proposal Addendum
❑ Professional Services R Amendment
❑ Bid Opening E] Bid Award ❑ Req. to Advertise ❑ Title Sheet
El Quote Opening El Quote Award
❑ Chg Order No. El C/O & PCA No. PCA
Ease./Encroach. Traffic Control ❑ Resolution
R Other: If-1Claim
_
Required Information
Company or Vendor Name
United Wa of St. Joseph County
If Yes, Approved by Purchasing
New Vendor
® No
MBE/WBE Contractor
❑ MBE Completed E-Verify Form Attached El Yes
WBE ❑ No
Project Name
Neighbor to Neighbor Engagement __..__ ..._............................ ......
Project Number
19JO24
Funding Source
EDIT
Account No.
...........
408-1001-460._.3.1.....06................................... _www _.........__.....,,, �..m.
Amount
Not to exceed t25,000
Terms of Contract
March 1 2019-December 3���1, 2019
Purpose/Description
Nei hborhood Programs &........_......_ �..
Services
For Change Orders Ondr ITmmm
....................._ .... _.
Amount of El Increase $
F] Decrease $
Previous Amount $
Current Percent of Change;
New Amount $
Total Percent of Change:
Time Extension:
Dispersal After Approval
Copy Original