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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />07-25-17 <br />Caot. Voros <br />Purchasing ❑ <br />Department SBPD <br />U Agreement <br />Contract F1 Proposal ❑Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />F-1 Other: <br />Company or Vendor Name South Bend Polic <br />New Vendor ❑ Yes ® No [ <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />If Yes, Approved by Purchasing <br />Name of Company <br />Purchase of retired K9 Otter by handler Officer Kline <br />$ 1.00 <br />The South Bend Police De artme approval p ,,nt requests BPW a rova of the,,..... <br />resolution for the retirement the 10yr old K9 Otter and the purchase <br />of Otter by the handler An ie Kline for $1.00 and all expenses <br />incurred in connection with the dog after its retirement. <br />❑ Required Contractors Certification Form <br />m Attached (Non - <br />Collusion, Nan -Discrimination Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Capt. Voros <br />Dispersal After Approval <br />