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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />1111MIRE <br />ERM M <br />#,epartment SBPD <br />BPW Date 02-13-18 Phone Extension 7520 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name Clara McDaniels <br />Controller Ei 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 El <br />U Agreement El Contract E:1 Proposal A-ddenidum <br />F� Professional Services M Resolution f --d\0 - <br />[:1 Bid Opening El Bid Award El Req. to Advertise E] Title Sheet <br />r_1 Quote Opening F11 Quote Award <br />❑ Change Order No. El C/O & PCA No. E:1 PCA <br />❑ Ease/Encroach. El Traffic Control <br />El Other: <br />Reau'red Information <br />Company or Vendor Name <br />New Vendor El YesEl No M If Yes, Approved by Purchasing <br />MBEANBE Contractor [:] MBEFI WBE <br />MBENVBE Contractor Requested [:] No [:] Yes Name of Company <br />Project Name - Retirement gift of firearm to Christopher Voros <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Uri 107 Am M41 <br />The South Bend Police Dept. regluests that the Board of Public <br />Works declare Officer Christopher Voros, Smith & Wesson handgun <br />as surplus property no longer useful to the city, Serial No <br />HIVVD88010.This declaration will authorize the presentation of the <br />above listed firearm as, a tribute for his 20 yrs, of service to the Cily. <br />Retired: 02-02-18 <br />[:] Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc,) <br />❑ Increase $ <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of' Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />N <br />❑ <br />E] <br />❑ <br />