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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />01-24-18 <br />Sgt. Goben Department SBPD <br />BPW Date 02-13-18 Phone Extension 7520 <br />- Required Prior to Submittal to Board <br />Legal Z Attorney Name Clara McDaniels <br />Controller Eii 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 />uneCK inne iAAp r _� p nets item ,w pe �_.Hequlred tor All Submissions <br />[J Agreement H Contract TN El Proposal El Addendum <br />El Professional Services Resolution <br />F-1 Bid Opening Bid Award' F1 Req. to Advertise El Title Sheet <br />F-1 Quote Opening F-1 Quote Award <br />F1 Change Order No. F11 c/o & PCA No. El PCA <br />El Ease/Encroach. F-1 Traffic Control <br />❑ Other: <br />Reauted Information <br />Company or Vendor Name <br />New Vendor 0 Yes Ej No El If Yes, Approved by Purchasing <br />MBENVBE Contractor [:1 MBE M WBE <br />MBE/WBE Contractor Requested ❑ No [:] Yes Name of Company <br />Project Name Retirement gift of firearm to Michael Grant <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Diescription <br />Amount of F1 <br />D <br />U. <br />The South Bend Police Dept, re nests that the Board of Public <br />Works declare Officer Michael GrantSmith & Wesson haodgun as <br />surglus property no longer useful to the city. Serial No <br />HKB3770.This declaration will authorize the presentation of the <br />above listed firearm as a tribute for his 45 yrs of service to the City. <br />Retired: 02-01-18 <br />El Required Contractor's Certification Form Attached (Non- <br />Coflusion, Non -Discrimination, Non -Debarment, E,-Verifv, Iran, etc.) <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 />❑ <br />Scat. Goben <br />Dispersal After Approval <br />