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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/21/17 <br />Name Jeff Hudak Department Central Services <br />BPW Date 7/11/17 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 />f-I 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 0 Yes Name of Company <br />Spec Q — Four (4) more or less 2017 or Newer Police Motorcycles <br />with Equipment <br />2017 Police Department Motor Equipment Fund <br />220-8101-421-43-02 <br />I <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc. <br />Amount of U 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 />® ❑ Ken Glowacki, Chris Voros, Don Galeziewski <br />❑ ❑ <br />