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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 17, 2018 <br />Name Pam Meyer Department DCI <br />BPW Date December 20, 2018 Phone Extension 5845 <br />wwww umirrr uwvmw�mm mommmo mmmmmmmmmmmmmmmmmmU0000mmmmommummmmmmmmuuuummmmmmmmwmuwmmmwwrw you.. l �wmmmmMPNNimoommmmm�Nffli <br />_. .- <br />............. Re uired Prior to _._...._________..�.................W_ _. ....... ��.�...... ......... " ..........._... �.�� Submittal to Board �_.. <br />Legal Attorney Name Sandra Kennedy <br />Controller Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing F <br />Check the <br />Z Agreement <br />❑ Professional Services <br />Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. _ <br />❑ Ease/Encroach. <br />❑ Other: <br />)ro IT.riate Item Type <br />❑ Contract <br />❑ Resolution <br />E Bid Award <br />El Quote Award <br />F-1 C/O & PCA No. <br />❑ Traffic Control <br />for All Submissions <br />I Proposal [� Addendum <br />[] Req. to Advertise ❑ Title Sheet <br />uired Information <br />❑ PCA <br />Company or Vendor Name 466 Works Community Development Corporation Inc. <br />New Vendor <br />El Yes E No 0 If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />Project Name <br />Pilot Housing Subsidy Program New Housing Construction <br />Project Number <br />18JO15 <br />FundingSource <br />.._..EDIT �.�......._...............................................�__________- �....�........................������...,.� y _ - - ,... �.... <br />Account No. <br />408.1001.460.39.30 �... m....._ _w <br />Amount <br />$ 500,000.00 <br />Terms of Contract <br />1/l/19-12/3�1./2.0�2................................................_.................... _ .�......m.............. <br />Purpose/Description <br />Subsidize contractution of 7 homes in Southeast Neighborhood orhood <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc,) <br />Amount of El Increase $ <br />F-1 Decrease $ <br />Previous Amount $ <br />Current Percent of Change:.,_.. . <br />New Amount $ <br />Total Percent of Change: <br />Copy Original <br />® ® Pam M <br />El El <br />_. <br />red For Change Orders On <br />Dispersal After Approval <br />DCI <br />