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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11/7/17 <br />Jeff Hudak <br />Department Central Services <br />jJ <br />Agreement <br />U Contract [J Proposal U Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />® <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ Change Order No. <br />❑ <br />CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />R Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBENVBE 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 />El <br />ERS-OCI Wireless <br />❑ Yes Z No ❑ If Yes, Approved by Purchasing <br />F-1 MBE n WBE <br />❑ No ❑ Yes Name of Company <br />Spec AB — Equipment Installations in 2017 Ford Police Interceptor <br />Sedans <br />2017 Police Department Capital Principal 404-0401-415-37-11 & <br />Interest 404-0401-415-37-12 fsubiect to lease funding) <br />$ 37,935.00 (27 @ $1,405.00 each) <br />Bid Opening Date: 10/24/17 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non-Discrirnination, 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 />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />Jeff Hudak & Sheila Enos <br />Ken Glowacki, Chris Voros, Don Galeziewski <br />