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Date <br />Name <br />BOARD OF PUBLIC WORICS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/18/17 <br />Jeff Hiudak <br />Department —Central Services <br />BPW Date 12/21/17 Phone Extension 574-235-91316 <br />Required Prior to Submittal to Board <br />Legal Attorney Name Catherine Fanello <br />Controller E] 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 <br />M Michael Schmidt <br />0 Agreement <br />H Contract H Proposal H Addendum <br />F-1 Professional Services <br />E] <br />Resolution <br />[:1 Bid Opening <br />E <br />Bid Award El, Req. to Advertise El Title Sheet <br />F1 Quote Opening <br />F-1 <br />Quote Award <br />[] <br />Change Order No. <br />❑ C/O & PCA No, ❑ PCA <br />El <br />Ease/Encroach. <br />❑ Traffic Control <br />F1 <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE 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 />WITZIMM <br />Previous Amount <br />Jordan Ford <br />Ll Yes LA No H If Yes, Approved by Purchasing__ <br />F-1 MBE F1 WBE <br />El No El Yes Name of Company_ <br />Spec Al — One (1) or more 2018 or Newer Standard 4X4 4 Door <br />Utility Vehicle <br />2017 Police Department Capital Principal 404-0401-415-37-11 & <br />Interest 404-0401-415-37-12 (subject to lease, funding) <br />011MMM <br />Bid Opening Date: 12/21/117 <br />R Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment, E-Verifv, Iran, etc. <br />F1 increase <br />E] Decrease <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />F1 <br />El <br />F <br />Dispersal Afte, Approval <br />Jeff Hudak & Sheila Enos <br />Ken Glowacki, Chris Voros, Don Galeziewski <br />