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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 08-31-16 <br />Name Capt. Voros Department <br />BPW Date 09-13-16 Phone Extension 7770 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® 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 />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />F1 Ease/Encroach. ❑ Traffic Control <br />Information <br />Company or Vendor Name On Duty Depot <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name 2015 South Bend Police Vehicle Equipment <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />11L12 <br />Award bid for items 2.4,5,6,7,8 12 13 14,15,16,17 18 19,21 22,23, <br />Amount of U Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />Voros <br />Required Contractor's Certification Form Attached (Non- <br />lusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc <br />For Change Orders <br />Dispersal After Approval <br />