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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />07-19-17 <br />Capt. Voros <br />Purchasing <br />Department SBPD <br />❑ Agreement <br />U Contract LJ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />® <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />F-1 <br />Other: <br />Company or Vendor Name On Duty Depot <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEMBE Contractor ❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company. <br />Project Name 2017 South Bend Police Vehicle Eau <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Vehicle lease <br />404.0401.415.37.111.12 <br />$ 171,189.00 <br />nt <br />............................................................. <br />Purpose/Description Award bid for items 2 4 5 6 7 8 10 16 17 18, 19 20 21 22 23 <br />24, 25, 26, 27, 29, 33, 34, 35, and 37 to On ,Duty -Depot as lowest <br />bidder for said items. <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 />® ❑ Capt. Voros <br />❑ ❑ <br />❑ ❑ <br />