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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />1►►IilsIVINI ►APOI :I <br />Jeff Hudak <br />Department Central Services <br />❑ <br />Agreement <br />❑ <br />Contract ❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ <br />Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ® Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />❑ Other: <br />3 Required Information <br />Company or Vendor Name <br />New Vendor <br />❑ <br />Yes ❑ <br />No ❑ If Yes, Approved_ by Purchasing <br />MBE/WBE Contractor <br />❑ <br />MBE ❑ WBE <br />MBE/WBE Contractor <br />Requested <br />❑ No ❑ Yes Name of Company <br />Spec G —three (3) more or less 2018 or Newer 28 cubic yard front <br />Project Name <br />loading refuse trucks for Solid Waste. <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />2018 Capital Lease - principle 611-0610-415.37-11. Interest 611- <br />0610-415.37-12 <br />R. <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />% <br />Dispersal After Approval <br />Jeff Hudak <br />Mike Bronstetter <br />