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BOAI,ZD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/18/17 <br />Jeff Hudak <br />Department Central Services <br />BPW Date 12121/17 Phone Extension 574-235-9316 <br />Required Prior to Submittal to Board <br />Legal Attorney Name Catherine Fanello, <br />Controller El 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 0 George King <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE 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 II <br />I <br />H Contract <br />F-1 Resolution <br />Bid Award <br />❑ Quote Award <br />EJ C/O & PCA No. <br />[ 'Traffic Control <br />L] Proposal <br />Req. to Advertise <br />El PCA <br />El Title Sheet <br />1113, Yes a No 4 If Yes, Approved b Purchasing <br />y <br />VBE N WBE <br />El No El Yes Name of Company _ <br />Spec AH — One (1) or More New Four Wheel Drive Compact <br />Tractor With Quick Release Loader Bucket <br />2017 Department of Community Investment Capital Budget <br />405-1101-452-43-02 <br />$31,500.00 <br />Bid' Opening Date: 12/21/17 <br />[_] Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, 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 />Dispersal After Approval <br />Copy Original <br />❑ Jeff Hudak & Sheila Enos <br />❑ Randy Nowacki, Paul Moreland <br />El <br />