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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/22/16 <br />BPW Date 9/13/16 <br />Name Todd Skwarcan, Asst.Chief <br />Department <br />Fire <br />Phone 9255 <br />o <br />Legal ® <br />Attorney Name Michael Schmidt <br />a <br />Controller review is required for all Contracts $5,000.00 or more <br />07.2 <br />o <br />Controller ❑ <br />and greater than one year in length per the City Purchasing <br />( n <br />0 COPolicy <br />U) <br />Purchasing ❑ <br />Check the Aporooriate <br />Item Tvne — Reoi fired for Alf Suhmicsfnn.c <br />Agreement <br />I ❑ Contract I ❑ Proposal <br />❑ Addendum <br />❑ <br />Claim <br />❑ <br />Bid Opening <br />❑ Bid Award <br />❑ Re . to Advertise <br />❑ Title Sheet <br />❑ <br />Quote Open n <br />❑Quote Award <br />❑ <br />Chq Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ <br />Ease./Encroach. <br />❑ Traffic Control <br />esolution <br />❑ <br />Other: <br />Keauirea Intorrratlon <br />Company or Vendor Name <br />Michiana Wireless <br />New Vendor <br />❑ Yes ❑ <br />No ❑ If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />❑MBE <br />❑ <br />WBE <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />SBFD will allow Midwest Wireless to install a receiver and <br />transmitter on the Station 3's tower. Midwest will provide secured <br />internet access to SBFD Station 3 at no cost to the City. <br />For Ghanoe Orders Onlv <br />Amount of <br />❑ <br />❑ <br />Increase <br />Decrease <br />$ <br />$ <br />Previous Amount <br />1 $ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Copy <br />Original <br />❑ <br />❑ <br />Ulspersal Atter Approval <br />Cox <br />