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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/18/17 <br />Jeff Hudak <br />Department —Central Services <br />BPW Date 12/21/17 Phone Extension 574-235-9316 <br />Required Prior to Submittal to Board <br />Legal Z Attorney Name Catherine Fanello <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />2�• N <br />George King <br />F-1 Agreement <br />R Contract Ll Proposal LJ Addendum <br />R Professional Services <br />F1 Resolution <br />F-1 <br />Bid Opening <br />ZI <br />Bid Award F-1 Req. to Advertise E] Title Sheet <br />R <br />Quote Opening <br />E] <br />Quote Award , <br />El <br />Change Order No. <br />F-1 <br />C/O & PCA No. F] PCA <br />F-1 Ease/Encroach. <br />F-1 Traffic Control <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBEANBE Contractor <br />Req nested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Martin Country Chevrolet, Inc. <br />El Yes H No If Yes, Approved by Purchasing <br />n MBE n WBE <br />F] No F-1 Yes Name of Company <br />Spec AG - Two (2) More or Less 2018,or Newer Y2Ton Crew Cab <br />Four Wheel Drive Pickup Trucks <br />2017 Fire Department Capital Budget <br />287-0902-422-43-02 <br />$ 54,510.00 (2 @ $27,255.00 each) <br />Bid Opening Date: 12/21/17 <br />F] Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />307 "M -' 1! <br />F-1 Decrease <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal Aftar Approval <br />Copy <br />Original <br />F] <br />El <br />El <br />Jeff Hudak & Sheila Enos, <br />Todd Skwarcan <br />