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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July l lth, 2023 <br />Name PFC Aaron M. Knemer #2174 Department SBPD <br />BPW Date July 25th, 2023 Phone Extension 9018 <br />Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney ® Attorney Name Michael Schmidt <br />Dept. Attorney ® Attorney Name <br />Purchasing ❑ <br />Check the ADDronriate Item TVDe — <br />Kylie Connell <br />All Submissions <br />N Professional Services Agreement U Contract U 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 />n Other: n Ease./Encroach <br />Information <br />Company or Vendor Name CASIE Center / Saint Joseph County Special Victims Unit ( <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 />Yes ❑ If Yes, Approved by Purchasing <br />® No <br />MBE <br />❑ WBE Completed E-Verify Form Attached ❑❑ Yes <br />No <br />SBPD / CASIE Center / SVU 2023-2028 Service Exchange Agreement <br />Five (5) Years — January 1st. 2023 to December 31st. 2028 <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />Decrease <br />Increase <br />Decrease <br />