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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />814117 <br />Jeff Hudak <br />Department Central Services <br />BPW Date 8/22/17 Phone Extension 574-235-9316 <br />Legal ® Attorney Name Michael Schmidt <br />Controller ❑ 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 ® George King <br />Agreement <br />Contract Proposal Addendum <br />❑ <br />❑ <br />Professional Services <br />Bid Opening <br />❑ Resolution <br />❑ Bid Award ® Req. to Advertise ❑Title Sheet <br />❑ Quote Opening <br />❑ Change Order No. <br />❑ <br />❑ <br />Quote Award <br />CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />7 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE 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 />Amount of ❑ <br />❑ No ❑ Yes Name of Company <br />Spec Y — One (1) or more 2017 or Newer One Ton Four Wheel <br />Drive Pickup Truck Including Animal Transport Module <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 />® ❑ Ron O'Connor, Randy Wilkerson <br />