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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 21, 2018 <br />Name Stephen Cox, Fire Chief Department Fire <br />B,PW Date August 28, 2018 Phone Extension 9255 <br />Legal X Attorney Name Elliot Anderson <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F-1 <br />Agreement <br />0I Contract <br />E] Proposal LJ Addendum <br />Professional Services <br />F] Amendment <br />F-1 Bid Opening <br />F] Bid Award <br />E] Req. to Advertise El Title Sheet <br />❑ Quote Opening <br />El Quote Award <br />F-1 Chg Order No. <br />E] C/O & PCA No. <br />PCA <br />n Ease./Encroach. <br />❑ Traffic Control <br />❑ <br />Resolution <br />F-1 <br />Other: <br />El Claim <br />Company or Vendor Name <br />New Vendor <br />XWVWTVT: • r <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of L__J <br />El <br />Public Safety Medical <br />E] Yes E] If Yes, Approved by Purchasing <br />❑ No <br />MBE WBE No <br />Completed E-Verify Form Attached F� Yes <br />[:1 <br />South Bend Fire Department 2018 Service Agreement <br />Resolution consenting to the assignment of the South Bend Fire <br />Department 2018 Service Agreement that was approved by the <br />B,PW on 6/26/18 <br />For Change Orders Oily <br />Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change-, % <br />Time Extension: <br />NoninrSnl After Annroval <br />Copy <br />El <br />Original <br />E] Stephen Cox, Fire Chief <br />R Elliot Anderson, Assistant City Attorn <br />El <br />