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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/10/2019 <br />Name Mark Dollin er Department SBPD <br />BPW Date 12/19/2019 Phone Extension 7677 <br />WWW ITITITmm ITITITITIT Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ® <br />Attorney Name Geovanny Martinez <br />Purchasing <br />.. t__.. I�.....,,��� .�. q i " f. _.. ��. ..�_m .__ .... .Check the A � a•o ariat Item 1' �e �- /�� aaaaNe��l <aa� All Submissions ... ......_.........w... w.........__ <br />E] <br />Professional Services Agreement <br />❑ Contract <br />❑' Proposal <br />El <br />Open Market Contract <br />❑ Amendment/Addendum <br />Special Purchase, QPA <br />Bid Opening <br />❑ Bid Award <br />Req. to Advertise ❑ Title Sheet <br />E] <br />Quote Opening <br />❑ Quote Award <br />Reject Bids/Quotes <br />❑ <br />Proposal Opening <br />❑ C/O & PCA No. <br />❑ <br />PCA <br />Chg. Order, No. <br />❑ Traffic Control <br />Z Resolution <br />Other <br />ach <br />❑..Ease./Encro ._ .. .... ..... ........_._ <br />. �....�................ �_... __. . � <br />l uire.c1Information <br />Company or Vendor Name <br />.__..........._........_.........._..._._ <br />New Vendor <br />❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor <br />MBE Completed E-Verify Form Attached ❑ Yes <br />WBE ❑ No <br />Project Name <br />Retirement Gift of SBPDmfirearm to Keith Schweitzer m <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />The South Bend Police Department requests the Board declare Officer Keith <br />Schweitzer's Smith & Wesson M&P9 handgun, serial #NDT0959 as surplus <br />property no longer useful to the City. This declaration will authorize the <br />presentation of the above listed firearm as a tribute for his 31 years of service <br />to the +C itm Officer Schweitzer retired on November w 2019. <br />_ _.._ ......_ ......... <br />For Change Orders Only__._.�_ <br />Amount of <br />❑ <br />Increase $ <br />Decrease ($ <br />Previous Amount <br />$ ww �.......... ....................................���..��.....�....................�.....���....._............�.�...��..._� _...�_ <br />. .�.. .... �...........�.....,....... <br />a <br />Increase® <br />Current Percent of Change: <br />Decrease% <br />New Amount <br />Increase % <br />Total Percent of Change: <br />Decrease ( _. ... _... ..�....._...�_..._ ... ..mm..IT.m...�.�.IT.�........ <br />Time Extension Amount: <br />C cw oln . letion Date: <br />