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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />6/6/17 <br />Jeff Hudak <br />Department Central Services <br />BPW Date 6/13/17 Phone Extension 574-235-9316 <br />U Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />F1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE 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 />❑ No ❑'Yes Name of Company <br />Spec L — One (1) or more 2017 or Newer % Ton Extended Cab <br />Four Wheel Drive Pick Uo Truck <br />2017 Venues, Parks, & Arts Capital Lease 201-1101-452-37-11 & <br />Interest 201-1101-452-37-12 (subject to lease funding) <br />$ 38,029.00 <br />Bid Opening Date: 5/9/17 <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 />4 <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ❑ Jeff Hudak & Sheila Enos <br />® ❑ Cecil Eastman, Paul Moreland, & Aaron Perri <br />❑ ❑ <br />