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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 10, 2025 <br />Name Sgt. Aaron M. Knepper #2174 Department SBPD <br />BPW Date July 22" d, 2025 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 />Memorial Hospital Police Department <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />E] MBE <br />❑ WBE Completed E-Verify Form Attached ❑❑ Yes <br />No <br />Donation of Unusable Equipment (SBPD PBTs) <br />Requesting Board approval to donate equipment no longer used by the South <br />Bend Police Department. These are seven (7) Portable Breath Test devices. <br />These older devices are not used by SBPD but can be utilized by another <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 />For Change Orders <br />Increase <br />Decrease <br />Increase <br />Decrease <br />