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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />03/07/19 <br />Chief Lancaster <br />Department SBPD <br />BPW Date 03/26/19 Phone Extension 9301 <br />f WWW <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Geovanny Martinez <br />Controller E] 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 ❑ <br />Check the Aor <br />L J Agreement <br />Professional Services <br />Bid Opening <br />F1 Quote Opening <br />Change Order No. _ <br />E' Ease/Encroach. <br />F1 Other: <br />Company or Vendor Name <br />J Contract <br />® Resolution I�1 <br />❑ Bid Award <br />F Quote Award <br />El C/O & PCA No. <br />Traffic Control <br />i Submissions <br />Proposal <br />EJ Req. to Advertise <br />uired_ Information <br />❑ PCA <br />New Vendor E] Yes E] No ❑ If Yes, Approved by Purchasing <br />MBEM/BE Contractor ❑ MBE ❑ WBE <br />MBEM/BE Contractor Requested ❑ No R Yes Name of Company <br />Project Name Retirement gift of firearm to Ron Glon <br />Project Number <br />Funding Source <br />Account No. <br />Amount $ <br />Terms of Contract <br />Addendum <br />❑ Title Sheet <br />Purpose/Description The South Bend Police Dept. re uests that the Board of Public <br />Works declare Officer Ron Glon's Smith & Wesson M&P9 handgun <br />as surplus property no longer useful to the city, Serial No <br />HKB9835.This declaration will authorize the presentation of the <br />above listed firearm as a tribute for his vears of service to the Citv. <br />H Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Vrifv, Iran, etc. <br />Amount of Increase <br />Decrease <br />Previous Amount $_ <br />Current Percent of Changer <br />New Amount <br />juired For Change Orders O <br />$ .. .�. .._......... .................. <br />Total Percent of Change: % <br />..��.�.......................... .__.......... ............ <br />Dispersal After <br />Approval <br />Copy Original <br />® ❑ Chief Lancaster <br />.._._._._._ ........................ <br />❑ 71 <br />