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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/9/2020 <br />Name Mark Dollinger Department SBPD <br />BPW Date 9/22/2020 Phone Extension 7677 <br />Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer Officer Name Michael Patton <br />BPW Attorney ❑ Attorney Name Clara McDaniels <br />Dept. Attorney ❑< Attorney Name Geovanny Martinez <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required. for All Submissions <br />® Professional Services Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />❑ Other: ❑ Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Tire Rack <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑ MBE <br />❑ WBE <br />Indemnification <br />Completed E-Verify Form Attached <br />between COSB and Tire Rack <br />❑ Title Sheet <br />❑ Yes <br />❑ No <br />September 30, 2020-October 2, 2020 <br />The South Bend Police Department requests board approval of the <br />indemnification agreement between the City of South Bend and Tire Rack for the <br />use of Tire Rack's training track for police emergency vehicle operations (EVOvehicle operations (EVO) <br />For Change Orders Onl <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Combletion Date: <br />