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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 12, 2017 <br />Department Community <br />Name Beth Leonard Inks Investment <br />BPW Date May 23, 2017 Phone Extension 9330 <br />Legal x Attorney Name Ben Dougherty <br />Controller ElController review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />x Agreement <br />LJ Contract H Proposal U Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />n Other: <br />Company or Vendor Name Chamber of Commerce of St. Joseph Count <br />New Vendor <br />❑ Yes x No ❑ If Yes, Approved by Purchasing <br />MBENVBE Contractor <br />❑ MBE ❑ WBE <br />MBENVBE Contractor <br />Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Economic Development functions <br />Project Number <br />None <br />Funding Source <br />Economic Development Income Tax <br />Account No. <br />408-0401-415-39.30 <br />Amount <br />$ 115,000 <br />Terms of Contract <br />Thru 12/31/17 <br />Purpose/Description <br />Identifying economic development leads for the City <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verif ,Iran, etc. <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />❑ x <br />Jeff Rea, Chamber of Commerce <br />❑ x <br />Beth Leonard, Community Investment <br />❑ ❑ <br />