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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12-19-16 <br />Capt. Voros <br />Department SBPD <br />BPW Date 12-22-16 Phone Extension 7770 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />❑ Agreement ❑ Contract fi ❑ Proposal ❑ Addendum <br />❑ Professional Services ® Resolution j, V <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I-1 Other: <br />Company or Vendor Name <br />SBPD <br />New Vendor <br />❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Equipment disposal <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />The South Bend Police Department requests BPW approval to <br />dispose of old vehicle computer mounts through sale auction trade <br />or recycling. These mounts and parts are those removed from PD <br />vehicles due to upgrade, failure or damage due to crash. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verif , Iran, etc. <br />r.-equated For Ctaftg'flrs_4tC) ' ' <br />.%. <br />❑ Increase $ <br />Amount of <br />❑ Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Capt. <br />Voros <br />❑ ❑ <br />❑ ❑ <br />