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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/1 /17 <br />Name Jeff Hudak Department Central Services <br />BPW Date 5/9/17 Phone Extension 574-235-9316 <br />Re ` ired;Prior,to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />® George King <br />U <br />Agreement <br />L-I Contract L-J Proposal L.1 Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ <br />C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ <br />Traffic Control <br />F1 <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEMJBE Contractor <br />MBEIWBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Jordan Ford <br />Lj Yes N No La If Yes,..Approved by Purchasing <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Spec J — Three (3) more or less 2017 or Newer Front Wheel Drive <br />Cargo Vans <br />2017 Water Works Capital Budget <br />622-0640-415-43-02 <br />$ 68,247.00 <br />Bid Opening Date: 4/25/17 <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 />® ❑ -Al Greek, Bob Krol, Roxanne Lawson <br />❑ ❑ <br />