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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/18/21 <br />Name Mark Dollinger Department SBPD <br />BPW Date 03/9/21 Phone Extension 7677 <br /> <br />Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name Michael Patton BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Geovanny Martinez <br /> <br />Purchasing Daniel Parker <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 Title Sheet <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: Lease Agreement Ease./Encroach <br />Required Information <br />Company or Vendor Name ATF Project Disarm Task Force <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor MBE <br /> WBE Completed E-Verify Form Attached Yes <br /> No <br />Project Name ATF Lease <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description SBPD is seeking approval of a lease agreement with the ATF in which the ATF <br />leases space at the SBPD Station located at 701 W. Sample St, South Bend, IN <br />46601. The term is for one year with the option for renewal. The ATF would <br />pay $10,795 for lease of the space. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ <br />($ ) <br />Previous Amount $ <br />Current Percent of Change: <br />Increase <br />Decrease <br /> % <br />( %) <br /> New Amount $ <br />Total Percent of Change: <br />Increase <br />Decrease <br /> % <br />( %) <br /> Time Extension Amount: <br />New Completion Date: <br />