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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/18/17 <br />Jeff Hudak <br />Department Central Services <br />BP VV Date 12/21/17 Phone Extension 574-235-9316 <br />Legal Attorney Name Catherine Fanello <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing George King <br />H Agreement <br />F1 Professional Services <br />0 Bid Opening <br />E] Quote Opening <br />n Change Order No. <br />F1 Ease/Encroach:. <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/BE Contractor <br />MBE/BE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of El <br />El <br />L Contract L] Proposal Addendum <br />F-1 Resolution <br />H Bid Award E] Req. to Advertise ❑ Title Sheet <br />F-1 Quote Award <br />F-1 C/O & PCA No. E] PCA <br />[:] Traffic Control <br />—Truck Centers, Inc. d/b/a Hill Truck Sales <br />El Yes M No ❑ If Yes, Approved by Purchasing <br />I®I MBE n WBE <br />El No El Yes Name of Company <br />Spec AD — One (1) or more 2017 or Newer Tandem Axle Multi-U'se <br />DumD Truck <br />2017 Street Department Capital Lease Principal 2012-0647-431-37- <br />12 & Interest 202-0647-431-37-11 1 (subject to lease funding) <br />$ 227,916.00 <br />Bid Opening Date: 12/21/17 <br />0 Required Contractor's Certification Form Attached (Non- <br />Coflusion. Non -Discrimination, Non -Debarment, E-Verffv, Iran, etc. <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amouint <br />Total Percent of Change: <br />Copy <br />Original <br />E] <br />El <br />n <br />Dispersal After Approval <br />Jeff Hudak & Sheila Enos <br />Derick Roberts, Pete Kaminski, Terri Swift <br />