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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW REQUEST FORM <br />12/18/17 <br />RW110501 <br />Department Central Services <br />BPW Date 12/21/17 Phone Extension 574-235-9316 <br />Required Prior to Submittal to Board <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 <br />H Agreement <br />El Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />F] Change Order No. <br />F-1 Ease/Encroach. <br />nI Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBE/WBE 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 />" Contract LJ Proposal Addendum <br />F] Resolution <br />E Bid Award El Req. to Advertise El Title Sheet <br />El Quote Award <br />El C/O & PCA No.❑ PCA <br />El Traffic Control <br />Required Infbirmation <br />Jordan Ford <br />❑I Yes M No [:1 If Yes, Approved by Purchasing <br />F1 MBE n WBE <br />El No El Yes Name of Company _ <br />Spec AK — Two (2) more or less 2018, or Newer 18,000 lb. Four <br />Wheel Drive Chassis with Dump Beds <br />2017 Street Department Capital Lease Principal 202-0647-431-37- <br />12 & Interest 202-0647-431-37-11 (subiect to lease funding) <br />Bid Opening Date: 12/21/17 <br />F1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non-Debairment, E-Verifv, Iran, etc. <br />Amount of n increase, $ <br />F] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />N <br />F <br />M <br />El <br />El <br />11 <br />Dispersal After Approval <br />Jeff Hudak & Sheila Enos <br />Derick Roberts, Pete Kaminski, Terri Swift <br />