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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />02-21-17 <br />Sgt. Goben Department <br />9 <br />BPW Date 2-28-17 Phone Extension 7520 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller El greater <br />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 />H Agreement LJ Contract Lj Proposal U Addendum <br />❑ Professional Services ® Resolution( -al) 1 i <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 />F1 Other: <br />Company or Vendor Name <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Retirement gift of firearm to Tim Medich <br />Project Number <br />Funding Source <br />Account No. <br />Amount $ <br />Terms of Contract <br />Purpose/Description The South Bend Police Dept. requests that the Board of Public Works <br />declare Officer Tim Medich's Smith & Wesson handgun as surplus <br />property no longer useful to the city. Serial No HKB4145.This declaration <br />will authorize the presentation of the above listed firearm as a tribute for <br />his 22yrs of service to the City. Retired: 02-28-17 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Amount of LI Increase <br />I-1 Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />❑ <br />