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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />02/27/19 <br />Division Chief Tim Lancaster <br />Department SBPD <br />BPW Date 03/12/19 <br />.. m <br />Phone Extension 9301 <br />_._....- <br />Rured Prior to Submittal to Board <br />Legal <br />Attorney Name OeovpDny Martinez <br />Controller <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El..... <br />_. <br />— Check the Appropriate <br />_ W_.__ <br />Item Tree Required for All Submissions <br />Agreement <br />g <br />ITITIT �- <br />Contract [� Proposal ❑ Addendum <br />Professional Services <br />® Resolution <br />F❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />El Quote Opening <br />R <br />Quote Award <br />❑ Change Order No. <br />F� <br />C/O & PCA No. ❑ PCA <br />F1 <br />Ease/Encroach. <br />Traffic Control <br />El <br />Other: <br />Required Information <br />Company or Vendor Name <br />New Vendor <br />❑ Yes ❑ No If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE F-1 WBE <br />MBE/WBE Contractor Requested ❑ No 7 Yes Name of Company <br />Project Name <br />Retiremeti <br />ngift of o Steve <br />f firearm tSte N._._. <br />Project Number <br />._ ...____ ._._.._._............................. __........................�..��.� <br />................. .............. ......... <br />Funding Source <br />........................... <br />Account No. <br />Amount <br />................................... <br />$.. <br />Terms of Contract <br />............. __ _......................_. ..........._ ___._._. <br />Purpose/Description <br />........��_ _...................................................... ......... .._���� <br />The South Bend Police De t. re nests that the Board of Public <br />Works declare Officer Steve Noonan's Smith & Wesson handgun as <br />surplus property no longer useful to the city. Serial No H B5073 , <br />This declaration will authorize the presentation of the above listed <br />firearm as a tribute for his years of service to the City. Retirement <br />date: 02-2-19. <br />EJ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment., E-Verify, Iran, etc. <br />Required For Change Orders OnIy_-_...._ ....... mITITITITmmµwwwwwwwwm <br />Amount of <br />Increase $ .. <br />Decrease $ <br />Previous Amount <br />................................ <br />Current Percent of Change: <br />_. <br />% <br />New Amount <br />$ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® E] Chief Lancaster <br />❑ ❑l.--_-_._......_.......-........_ .a........ <br />