Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />12/19/16 <br />Jeff Hudak <br />Department Central Services <br />BPW Date 12/22/16 Phone Extension 574-235-9316 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® George King <br />Agreement <br />Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />F1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Contract <br />Resolution <br />® Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo <br />❑ Traffic Control <br />Required Ini <br />Jordan Motors, Inc. <br />❑ Yes ❑ No <br />n MBE ❑ WBE <br />Proposal <br />❑ Req. to Advertise <br />am, <br />Purchasi <br />❑ Title Sheet <br />❑ No ❑ Yes Name of Company <br />Spec AC —One (1) more or less 2016 or Newer One Ton Two <br />Wheel Driver Dump Truck <br />2016 Water Works Capital Budget <br />622-0640-415-4302 _ <br />$ 48,493.00 <br />Bid Opening Date:11/22/16 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verify, 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 />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />Jeff Hudak & Sheila Enos & Mary Wisniewski <br />& Roxanne Lawson <br />