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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />04/24/ 19 <br />Div. Chief Tim Lancaster <br />Department SBPD <br />„a <br />BPW Date 05/07/19 Phone Extension 9301 <br />........ ......— .._.. - <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Geovanny Martinez <br />Controller ❑ 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 <br />LJ' Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. _ <br />❑ Ease/Encroach. <br />Other: Scecial Purch <br />Company or Vendor Name <br />wopriate Item T e — e uired for All Submissions <br />_..::..:.m.... ......... <br />Contract ❑ Proposal <br />® Resolution <br />❑ Bid Award �}, Req. to Advertise <br />❑ Quote Award <br />C/O & PCA No. ❑ PCA <br />F Traffic Control <br />Required Information <br />Addendum <br />❑ Title Sheet <br />New Vendor El Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor [:] MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Disposal of obsolete equipment & supplies <br />Project Number <br />...... ........... __-. ................................................ <br />Funding Source <br />............ .......................................... <br />Account No. <br />......................... ... ............ .... <br />�. <br />Amount <br />.....____.... _._.____....._ _........... _.... <br />Terms of Contract <br />Purpose/Description Reguesting board approval to dispose of obsolete e ui meat no <br />longer used by the South Bend Police Department, These items <br />include obsolete radio accessories. Pelican flashlights no longer <br />'issued to officers digital cameras no longer used by SBPD and <br />used uniforms no longer used by SBPD. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, N)n-Debarment., E Vdrify Iran, etc.) <br />Required For Change Ordersng O_m_ <br />Amount of ElIncrease $ mmITITITIT�mmmmmmm .._ .. <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change: % <br />NewAmount .............. .................. �......... -------------- <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ❑ Div. Chief Tim Lancaster <br />❑ ❑.__............................. <br />