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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/17/2025 <br />Name Erin Michaels <br />Department DCI <br />BPW Date 02/25/2025 Phone Extension 6022 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ® Attorney Name <br />Danielle Weiss <br />Purchasing ❑ <br />Check the Appropriate Item Type — RequirE <br />❑ Professional Services Agreement ❑ Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />❑ Quote Opening ❑ Quote Award <br />❑ Proposal Opening ❑ C/O & PCA No. <br />❑ Chg. Order, No. ❑ Traffic Control <br />® Other: Transfer Agreement <br />Reauired Information <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />All Submissions <br />❑ Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />Affordable HomeMatters Indiana, LLC <br />Intend Indiana <br />❑ Title Sheet <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Transfer of property to Intend Indiana. <br />Request to transfer of (6) City -owned parcels to Intend Indiana for <br />development of affordable housing. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />