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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/4/17 <br />Name Jeff Hudak Department <br />Purchasing ® George King <br />Central Services <br />Agreement Contract Proposal Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ® Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ CIO & PCA No. ❑ PGA <br />❑ Ease/Encroach. ❑ Traffic Control <br />17 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Req uested <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 />Yes ❑ No ❑ If Yes, Approved b Purchasing <br />F­1 MBE rI WBE <br />❑ No ❑ Yes Name of Company _ <br />Spec Z — One (1) or more 2017 or Newer Single Axle 4X4 Dump <br />Truck with Contractor Dump Bed <br />2017 Venues, Parks, & Arts Capital Principal 201-1101-452-37- <br />Interest 201-1101-452-37-12 (subject to lease funding) <br />11 <br />� <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 />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 />® ❑ Paul Moreland, Aaron Perri, Cecil Eastman <br />