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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/14/2019 <br />Name Mark Dollin er Department SBPD <br />BPW Date 11/26/201.9 Phone Extension 7677 <br />�� _........ .. .............. <br />... _ equirci Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney <br />Purchasing <br />E Attorney Name Geovangy Martinez <br />Check the Appr <br />opriate Item "1"we <br />H <br />Professional Services Agreement ❑ Contract <br />❑ <br />Open Market Contract ❑ Amendment/Addendum <br />❑ <br />Bid Opening E:1 Bid Award <br />Quote Opening ❑ Quote Award <br />Proposal Opening C/O & PCA No. <br />El <br />Chg. Order, No. R Traffic Control <br />E] Other: <br />Company or Vendor Name <br />All Submissions <br />❑ Proposal <br />(� Special Purchase, QPA <br />❑ Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA LI <br />® Resolution " 46 <br />Information <br />Ease./Encroach <br />❑ Title Sheet <br />New Vendor <br />❑❑ YesIf Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached ❑❑ Yes <br />No <br />Project Name <br />Retirement Gift of SBPD firearm to Jim McIntire <br />ProjectNumber <br />................................... ....... ...... .... ............ <br />Funding Source <br />............. ._ <br />Account No. <br />Amount..._. <br />......... ...................... .... ...... .. <br />Terms of Contract <br />Purpose/Description <br />The South Bend Police Department requests the Board declare Officer Jim <br />McIntire's Smith & Wesson M&P9 handgun, serial #NDT0754 as surplus property <br />no longer useful to the City. This declaration will authorize the presentation of the <br />above listed firearm as a tribute for his 32 years of service to the City. Officer <br />McIntire retired on November 4 2019. <br />For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease $ <br />Previous Amount <br />$ ....... <br />.............. ........_. <br />Increase % <br />Current Percent of Change: <br />Decrease % <br />New Amount <br />... <br />$ _ <br />Increase..........._ %.._.._..mm.......... � .._.......................�.__ ...._�._. <br />Total Percent of Change: <br />......... ° _ _� <br />Decrease /o <br />Time Extension Amount: <br />New Completion Date: <br />