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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW RE' QUEST FORM <br />Date February 19, 2018 <br />Name Pam Meyer Department _DC1 <br />February 27, 2018 <br />BPW Date Phone Extension 5845 <br />Required Prior to, 8ubmi J, <br />Legal Z Attorney Name Ben Dougherty <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 R <br />Agreement <br />❑ Professional Services <br />El Bid Opening <br />F-1 Quote Opening <br />F1 Change Order No. <br />F1 Ease/Encroach. <br />n Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />L] Contract <br />❑ Resolution <br />F] Bid Award <br />Quote Award <br />C/O & PCA No. <br />F-1 Traffic Control <br />ivy Tech Community College <br />IFTAT41140-41TON711 <br />El Req. to Advertise El Title Sheet <br />Yes N No LJ If Yes, Approved by Purchasing <br />MBE [:] WBE <br />N/A <br />N/A <br />N/A <br />N/A <br />$0.00 <br />Purpose/Description To accept donation of 7 modular buildings <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc., <br />Amount of H Increase <br />F-1 Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />H <br />M <br />El <br />F-1 <br />El <br />El <br />Dispersal After Approval <br />Pam Meyer, DC1 <br />