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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/14/17 <br />Name Jeff Hudak Department Central Services <br />BPW Date 6127/17 Phone Extension 574-235-9316 <br />Legal ® <br />Attorney Name Michael Schmidt <br />Controller ❑ <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />` Purchasing ® <br />George King <br />Check tie A <br />ro <br />riate Item T'` e Required .for All Submissions <br />❑ <br />Agreement <br />0 Contract ❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />❑ <br />Other: <br />Requlred Information <br />Company or Vendor Name <br />MacAllister Machinery Company <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor <br />Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Spec R — One (1) or more 2017 or Newer 40' Articulating Boom Lift <br />Project Number <br />2017 Venues, Parks, & Arts Capital Lease 201-1101-452-37-11 & <br />Funding Source <br />Interest 201-1101-452-37-12 (subject to lease funding) <br />Account No. <br />Amount <br />$ 45,500.00 <br />Terms of Contract <br />Purpose/Description <br />Bid Opening Date: 6/13/17 <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 />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 />