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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2-7-2017 <br />Department <br />Fire <br />BPW Date 2-14-2017 Phone 9255 <br />Name Todd Skwarcan <br />o Legal ® Attorney Name Michael Schmidt <br />o -u Controller review is required for all Contracts $5,000.00 or more <br />$ m Controller ❑ and greater than one year in length per the City Purchasing <br />j m° Policy <br />Purchasing ® George King <br />Check the Appropriate Item Type - Required for All Submissions <br />❑ Agreement <br />❑ Contract <br />❑ Proposal <br />I [-]Addendum <br />❑.Claim <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Reg. to Advertise <br />❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />® Other: Special <br />Purchase <br />Company or Vendor Name <br />5 Alarm Fire and Safety Equipment <br />New Vendor <br />.'Yes © <br />No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />Project Name <br />Project Number <br />Funding Source <br />EMS Capital Fund -Equipment Purchases <br />Account No. <br />287.0902.422.43-10 <br />Amount <br />$ 75,000 <br />Terms of Contract <br />Purpose/Description Purchase of Hurst extrication equipment <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease 1 $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />❑ ❑ <br />