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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 2nd, 2024 <br />Name Sgt. Aaron M. Knepper #2174 Department SBPD <br />BPW Date May 14th, 2024 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 />Kylie Connell <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 />n Other: n Ease./Encroach <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 />Information <br />CASIE Center / Saint Joseph County Special Victims Unit (SVU) <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />E] MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Neos <br />SBPD / CASIE Center / SVU 2023-2028 Service Exchanve Addendum <br />One (1) Year — January 1st, 2023 to December 315t, 2023 <br />For Chance 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 Completion Date: <br />