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F.M4 010 I -All 9 V DIJJ I N DMA I DMA731 tj 010111 <br />Date 01-24-18 <br />Name Sgt. Goben Department SBPD <br />BP,W Date 02-113-18 Phone Extension 7520 <br />Required Prior, to Submittal to Board <br />Legal Attorney Name, Clara McDaniels <br />Controller El Controller review is required for all Contracts $5,0100,.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />LJ Agreement El Contract El Proposal _E1 Addend —urn <br />F� Professional Services M Resolution �,b � ­ <br />Mi Bid Opening El Bid Award Fl Req. to Advertise El Title Sheet <br />F1 Quote Opening El Quote Award <br />Change Order No. [I C/O & PICA No. Ej PCA <br />❑ Ease/Encroach. F-1 Traffic Control <br />❑ Other: <br />Required Information <br />Company or Vendor Name <br />New Vendor ❑ Yes El No F-1 If Yes, Approved by Purchasing <br />MBEANBE Contractor M MBE F WBE <br />MBEA1VBE Contractor Requested El No F-1 Yes Name of Company <br />Project Name Retirement gift of firearm to Gary Horvath <br />Project Number <br />Funding Source <br />Account No. <br />Amount $ <br />Terms of Contract <br />Purpose/Description The South Bend Police Dept. reguests that the Board of Public <br />Works declare Officer Gaa-Horvath, Smith & Wesson handgun as <br />surplus prope[ly.no longer useful to the city. Serial No <br />HKB3755.This declaration will authorize the presentation of the <br />above listed firearm as a tribute for his 39 yrs of service to the City. <br />Retired: 05-31-18 <br />E:1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran. etc.) <br />Amount of F-1 increase <br />0 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 />H <br />El <br />F-1 <br />El <br />EJ <br />El <br />