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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />07-19-17 <br />Cavt. Voros <br />Purchasing <br />H Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />I� Other: <br />H Contract <br />❑ Resolution <br />® Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo. <br />❑ Traffic Control <br />Company or Vendor Name Crown North America <br />New Vendor ® Yes ❑ No <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes <br />Project Name 2017 South Bend <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Vehicle lease <br />Department SBPD <br />Proposal <br />❑ Req. to Advertise <br />If Yes, Approved by Purchasing <br />Name of Company <br />Police Vehicle Eauir)ment <br />404.0401.415.37.11 /.12 <br />$ 25,536.00 <br />❑ Title Sheet <br />Purpose/Description Award bid for items 30 31 and 32 to Crown North America as <br />lowest bidder for said items. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of H 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 />Cant. Voros <br />Dispersal After Approval <br />