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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/11/17 <br />Name Jeff Hudak Department <br />Central Services <br />Agreement <br />F1 Contract <br />Proposal Addendum <br />❑ Professional Services <br />❑ Bid Opening <br />❑ <br />® <br />Resolution <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />F-I <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE 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 />Bobcat of Michiana <br />Yes F1 No ❑ If Yes, Approved by Purchasing <br />❑ No ❑ Yes Name of Company <br />Spec K -- One (1) or more 2017 or Newer Compact Track Loader <br />2017 Venues, Parks, & Arts Capital Principal 201-1101-452-37-11 & <br />Interest 201-1101-452-37-12 (subject to lease fundin ) <br />$ 57,299.29 <br />Bid Opening Date: 519117 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, 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 />❑ 0 <br />