Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/14/17 <br />Name Jeff Hudak Department Central Services <br />LJ Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. _ <br />❑ Ease/Encroach. <br />[� Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBEANBE 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 />Previous Amount <br />❑ No ❑ Yes Name of Company <br />Spec U — One (1) or more New Positive Displacement Hydro- <br />Excavatina Machine with Tandem Axle Cab & Chassis <br />2017 Water Works Capital Budget <br />622-0604-415-43-02 <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment, E-Verify, Iran, etc. <br />❑ increase $ <br />❑ Decrease $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />Jeff Hudak & Sheila Enos <br />Bob Krol, Roxanne Lawson, Al Greek <br />