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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />3/27/17 <br />Jeff Hudak <br />Agreement <br />Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />I-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE 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 />U Contract <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo. <br />❑ Traffic Control <br />Department Central Services <br />Proposal <br />® Req. to Advertise <br />Addendum <br />❑ Title Sheet <br />U Yes U No Ll If Yes, Approved by Purchasing <br />❑ MBE ❑ WBE <br />_❑ No ❑ Yes Name of Company <br />Spec K — One 1 or more 2017 or Newer Compact Track Loader <br />2017 Venues, Arts, & Parks Capital Principal 201-1101-452-37-11 & <br />Interest 201-1101-452-37-12 (subject to lease funding) <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of ❑ 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, Cecil Eastman <br />❑ ❑ <br />