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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />9/13/17 <br />Jeff Hudak <br />Department Central Services <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />❑ Contract ❑ Proposal U Addendum <br />❑ Resolution <br />❑ Bid Award ® Req. to Advertise ❑ Title Sheet <br />❑ Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control <br />Required Information <br />Company or Vendor Name <br />New Vendor <br />El Yes ❑ No If Yes, Approved by Purchasing <br />MBEMIBE Contractor <br />❑ MBE ❑ WBE <br />MBEMIBE Contractor <br />Requested <br />❑ No ❑ Yes Name of Company <br />Spec AB -- Equipment Installations in 2017 Ford Police Interceptor <br />Project Name <br />Sedans <br />Project Number <br />2017 Police Department Capital Principal 404-0401-415-37-11 & <br />Funding Source <br />Interest 404-0401-415-37-12 (subject to lease funding) <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verify, 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 />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />Dispersal After Approval <br />Jeff Hudak & Sheila Enos <br />Ken Glowacki, Chris Voros, Don Galeziewski <br />