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Home My WebLink AboutRequest to Advertise - Lead Hazard Grant HUD OLHCHH IHCDABOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 2/15/2021 Name Liz Maradik Department DCI BPW Date 2/23/20 Phone Extension x5821 Review and Approval Required Prior to Submittal to Board Diversity Compliance and Inclusion Officer Officer Name Michael Patton BPW Attorney Attorney Name Clara McDaniels Dept. Attorney Attorney Name Sandi Kennedy Purchasing Michael Schmidt Check the Appropriate Item Type – Required for All Submissions Professional Services Agreement Contract Proposal Open Market Contract Amendment/Addendum Special Purchase, QPA Bid Opening Bid Award Req. to Advertise Title Sheet Quote Opening Quote Award Reject Bids/Quotes Proposal Opening C/O & PCA No. PCA Chg. Order, No. Traffic Control Resolution Other: Ease./Encroach Required Information Company or Vendor Name New Vendor Yes If Yes, Approved by Purchasing No MBE/WBE Contractor MBE WBE Completed E-Verify Form Attached Yes No Project Name Lead Hazard Reduction Pre-Qualified Contractors Registry Project Number Funding Source HUD Office of Lead Hazard Control & Healthy Homes (OLHCHH) Lead Hazard Reduction Grant Account No. Amount Terms of Contract Purpose/Description RFQ to establish a registry of pre-qualified lead contractors who will be notified of opportunities to bid on Lead Hazard Reduction Program work. For Change Orders Only Amount of Increase Decrease $ ($ ) Previous Amount $ Current Percent of Change: Increase Decrease % ( %) New Amount $ Total Percent of Change: Increase Decrease % ( %) Time Extension Amount: New Completion Date: BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 2/15/2021 Name Liz Maradik Department DCI BPW Date 2/23/20 Phone Extension x5821 Review and Approval Required Prior to Submittal to Board Diversity Compliance and Inclusion Officer Officer Name Michael Patton BPW Attorney Attorney Name Clara McDaniels Dept. Attorney Attorney Name Sandi Kennedy Purchasing Michael Schmidt Check the Appropriate Item Type – Required for All Submissions Professional Services Agreement Contract Proposal Open Market Contract Amendment/Addendum Special Purchase, QPA Bid Opening Bid Award Req. to Advertise Title Sheet Quote Opening Quote Award Reject Bids/Quotes Proposal Opening C/O & PCA No. PCA Chg. Order, No. Traffic Control Resolution Other: Ease./Encroach Required Information Company or Vendor Name New Vendor Yes If Yes, Approved by Purchasing No MBE/WBE Contractor MBE WBE Completed E-Verify Form Attached Yes No Project Name Lead Hazard Reduction Pre-Qualified Contractors Registry Project Number Funding Source Indiana Housing & Community Development Authority (IHCDA) Lead Hazard Reduction Grant Account No. Amount Terms of Contract Purpose/Description RFQ to establish a registry of pre-qualified lead contractors who will be notified of opportunities to bid on Lead Hazard Reduction Program work. For Change Orders Only Amount of Increase Decrease $ ($ ) Previous Amount $ Current Percent of Change: Increase Decrease % ( %) New Amount $ Total Percent of Change: Increase Decrease % ( %) Time Extension Amount: New Completion Date: