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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/6/17 <br />Name Jeff Hudak Department Central Services <br />BPW Date 6113/17 Phone Extension 574-235-9316 <br />H Agreement <br />H Contract LJ Proposal LJ Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />® <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />R <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 />Jordan Ford <br />U Yes X No LJ If Yes, Approved by Purchasing <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Spec M -- Seven (7) more or less 2017 or Newer 3/ Ton Four Wheel <br />Drive Pick Un Trucks <br />2017 Venues, Parks, &Arts Capital Lease 201-1101-452-37-11 & <br />Interest 201-1101-452-37-12 (subject to lease funding), <br />2017 Organic Resources Capital Budget 642-0630-415-43-02, <br />2017 Code Enforcement Capital Lease Principal 612-1201-415-37- <br />11 & Interest 612-1201-415-37-12 (subject to lease funding) <br />Amount $138,636.00 Venues, Parks, & Arts <br />$ 34,659.00 Organic Resources <br />$ 69,318.00 Code Enforcement <br />$242,613.00 Grand Total <br />Terms of Contract <br />Purpose/Description Bid Opening Date: 5/9/17 <br />Amount of <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />