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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11 /28/16 <br />Timmer <br />Department DCI <br />BPW Date 12/13/16 Phone Extension 5841 <br />I Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name Michael Schmidt <br />Controller El <br />review is required for all Contracts $5,000.00 or more and <br />greater <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 />® <br />Other: Amendment <br />[red Information <br />Company or Vendor Name Department of Code Enforcement <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name Vacant and Abandoned Building Demolition Program <br />Project Number 15-JC-14 <br />Funding Source Community Development Block Grant (CDBG) <br />Account No. 212.1001.460.39.30 <br />Amount $300,000 (there will be no change in contract amount) <br />Terms of Contract 1/01/15 — 12/31/17 <br />Purpose/Description Extend the contract timetable by 12 months through 12/31/17 to <br />allow for project completion <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion 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 />Dispersal After Approval <br />Copy Original <br />® ❑ Judy Love <br />❑ ❑ <br />❑ ❑ <br />