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BOARD OF PU13LIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/5/2017 <br />Department <br />Fire <br />BPW Date 12/12/2017 Phone 9255 <br />Name Todd Skwarcan, A/C Services <br />. . ... . ....... <br />. ..... . ....... . <br />0 Legal Attorney Name Clara McDaniels <br />-0 +- <br />a) 0 '— Controller review is required for all Contracts $5,000.00 or more <br />�2 -2 <br />:t--1 m Controller and greater than one year in length per the City Purchasing <br />ry <br />cr.2 E 0 <br />0 " _a M Policy <br />0- :� <br />Purchasing ❑ Michael Schmidt <br />Check the ADDroDriate, Item TvDe - Rpouirpd for Allijhmis.Rinns <br />--M <br />Agreement <br />El contract El Proposal' <br />❑ Addendum <br />E1 <br />Claim <br />F-1 <br />Bid Opening <br />❑ <br />Bid Award <br />Reg. to Advertise <br />e Sheet <br />El <br />Quote Opening <br />F-1 <br />Quote Award <br />El <br />Chg Order No. <br />❑—C/O <br />8"PCA No. <br />E] PCA <br />El <br />Ease./Encroach. <br />❑ Traffic Control <br />El Resolution <br />Other: <br />EEEEE] <br />Required Information <br />Company or Vendor Name <br />-B,rjnd,1,ee-MountaJn 0,1i-t <br />New Vendor <br />H <br />Yes El No E] If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />❑ <br />MBE F WBE <br />Project Name <br />Project Number <br />Funding Source <br />Capital Account/Vehicles <br />Account No. <br />750.0000.413.43-02 <br />Amount <br />$63,500 <br />Terms of Contract <br />Purpose/Description <br />Purchase of used 2003 Pierce Contender Rescue Pumper <br />=9- 606113merfil <br />Amount of <br />� El <br />El' I <br />increase $ <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Dispersal After Approval <br />Copy <br />Original <br />M <br />0 Todd Skwarcan <br />1-1 <br />El <br />