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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/1 /17 <br />Name Jeff Hudak Department <br />Central Services <br />BPW Date 6/13/17 Phone Extension 574-235-9316 <br />Legal ® Attorney Name Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® George King <br />U <br />Agreement <br />U <br />Contract U Proposal L ,j Addendum <br />❑ <br />Professional Services <br />❑ <br />Resolution <br />❑ <br />Bid Opening <br />® <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />F- <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ <br />Altec Industries, Inc. <br />_® Yes No ❑ If Yes, Approved by Purchasing <br />n MBE n WBE <br />_❑ No ❑ Yes _Name of Company <br />Spec O — One (1) or more 2017 or Newer 70' Aerial Four Wheel <br />Drive Tower Truck Complete <br />2017 Venues, Parks, & Arts Capital Lease 201-1101-452-37-11 & <br />Interest 201-1101-452-37-12(subject to lease funding) <br />$ 200,147.00 <br />Bid Opening Date: 5/23/17 <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 />® <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />Jeff Hudak & Sheila Enos <br />Cecil Eastman & Paul Moreland & Aaron Perri <br />