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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />3/7/17 <br />Jeff Hudak <br />Department Central Services <br />BPW Date 3/14/17 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 <br />® George King <br />H 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 />❑ Ease/Encroach. ❑ Traffic Control <br />❑ 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 />LJ Yes LJ No LJ If Yes, Approved by Purchasing <br />❑ MBE ❑ WBE <br />No ❑ Yes Name of Cc <br />Spec H — Ten (10) more or less Commercial Riding Mowers <br />2017 Venues Parks & Arts Capital Lease Principal 201-1101-452- <br />3711 & Interest 201-1101-452-3712 (subject to lease funding) <br />Bid Opening Date: 3/14/17 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment, E-Verifv. Iran. et( <br />Increase <br />Decrease <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ Jeff Hudak & Sheila Enos <br />❑ ❑ Paul Moreland & Aaron Perri <br />❑ ❑ <br />