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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />5/10/17 <br />Jeff Hudak <br />Department Central Services <br />Agreement <br />❑ <br />Contract ❑ Proposal U Addendum <br />❑ <br />Professional Services <br />❑ <br />Resolution <br />❑ <br />Bid Opening <br />® <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Change Order No. <br />❑ <br />C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ <br />Traffic Control <br />F-1 <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBEANBE Contractor <br />Req uested <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 />El <br />............. .......... . <br />Vermeer of Indiana <br />❑ Yes Z No ❑ If Yes, Approved by Purchasing <br />[-I MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Soec I - One (1) or more 2017 or Newer Tub Grinder <br />2017 Organic Resources Capital Lease Principal 641-0631-793-37- <br />11 & Interest 641-0631-793-37-12 (subject to lease funding_ <br />$ 546, 090.28 <br />Bid Opening Date: 4/25/17 <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 />0 <br />p/0 <br />Dispersal After Approval <br />Jeff Hudak & Sheila Enos <br />Kevin Ott <br />