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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/9/18 <br />Name Jen Hockenhull <br />Department A/F <br />_BPW Date 1/23/18 Phone Extension 9822 <br />Required Prior to Submittal to Board <br />Legal Attorney Name Ashley Mills Colborn <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller Z and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing E <br />Check the Appropriate <br />Item Type — Required for All Submissions <br />M Agreement <br />N <br />Contract <br />F1 Proposal El Addendum <br />Professional Services <br />[:] <br />Amendment <br />❑ Bid Opening <br />n <br />Bid Award <br />El Req. to Advertise E] Title Sheet <br />❑ Quote Opening <br />F-1 <br />Quote Award <br />F-1 Chg Order No. <br />n <br />C/O & PCA No. <br />E] PCA <br />F-1 Ease./Encroach. <br />F] <br />Traffic Control <br />n Resolution <br />F-1 Other: <br />F-1 Claim <br />Required Information <br />Company or Vendor Name St Joseph County <br />New Vendor El Yes F-1 If Yes, Approved by Purchasing <br />0 No <br />MBEANBE Contractor [:]� MBE Completed E-Verify Form Attached El Yes <br />F-1 WBE N o <br />Project Name Special Victims Unit Operations Agreement <br />Project Number n/a <br />Funding Source COLT <br />Account No. 404-0401-415.37-03 <br />Amount $40,000 annually for 5 years <br />Terms of Contract Pay annually based on invoice from County <br />Purpose/Description Operations of the Special Victims Unit in conjunction with St. <br />Joseph County Prosecutor's office for a term ending December <br />Amount of LJ Increase $ <br />F-1 Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy <br />Original <br />M <br />F-1 <br />F] <br />Dispersal After Approval <br />Jennifer Hockenhull <br />-Ashley Colborn <br />Dannv Cocano,wer <br />