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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/7/17 <br />Name Jitin Kain <br />BPW Date 3/14/17 <br />Department Public Works <br />Phone Extension 5835 <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 />� Agreement U Contract U Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I-1 Other: <br />Company or Vendor Name Catalaunch, LLC d/b/a Patronicity <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBEANBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name MLK-Hesburgh Monument <br />Project Number <br />Funding Source <br />Account No. <br />Amount $ 20,000 <br />Terms of Contract <br />Purpose/Description Grant agreement with Patronicity for disbursement of funds for the <br />MLK-Hesburgh monument in downtown South Bend. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Amount of I_I Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />E <br />Linda Martin <br />Jitin Kain <br />Dispersal After Approval <br />