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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 16, 2017 <br />Name Pam Meyer <br />March 28, 2017 <br />Department DCI <br />BPW Date Phone Extension 5845 <br />Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name Michael Schmidt, <br />Controller ® <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® <br />George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement <br />® Contract ❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />F1 <br />Other: <br />Required Information <br />Company or Vendor Name South Bend Police Department <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />J Yes El No LJ If Yes, Approved by Purchasing <br />] MBE ❑ WBE <br />Neighborhood Action Reclamation Patrols Program <br />CDBG Funds <br />Fund 212 <br />$ 90,000 <br />January 1, 2017 - December 31, 2017 <br />Personnel costs attributed to Neighborhood Foot and Bike Patrol services <br />in low and moderate income neighborhoods <br />® Required Contractor's Certification Form Attached (Non - <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />F-1 <br />❑ <br />❑ <br />Pam Meyer, DCI <br />Orders On <br />Approval <br />