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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07-15-16 <br />Name Capt. Voros Department SBPD <br />BPW Date 07-26-16 Phone Extension 7770 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ® Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />F-1 Other: <br />Information <br />Company or Vendor Name <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name 2016 South Bend Police Vehicle Equipment Bid <br />Project Number <br />Funding Source 2016 Police Department Capital lease <br />Account No. 404.0401.415.37.11/.12 <br />Amount $ <br />Terms of Contract <br />Purpose/Description The South Bend Police Department requests BPW approval to <br />X Required Contractor's Certification Form Attached (Non - <br />Collusion. Non-Discrimination _ Non-Daharmant F-\/arifv Iran oft <br />Amount of " Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change: _ <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Voros <br />Orders <br />Dispersal After Approval <br />47 r <br />