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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />March 9. 2018 <br />Jeff Hudak <br />Department Central Services <br />BPW Date March 27, 2018 Phone Extension 574-235-9316 <br />Re uired'Prior, to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <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 Michael Schmidt <br />Company or Vendor Name <br />New Vendor <br />MBEMIBE Contractor <br />MBEMVBE 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 ❑ <br />El <br />Required Information <br />LJ Yes LJ No LJ If Yes, Approved by Purchasing <br />I-1 MBE M WBE <br />❑ No ❑ Yes Name of Company _ <br />Spec 1 — One (1) more or less 2018 or Newer 314 Ton Two Wheel <br />Drive Pick Up Trucks <br />2016 Water Works Capital Budget <br />622-0640-415-43-02 <br />Bid Opening Date: <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 />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />Jeff Hudak <br />Roxanne Lawson & Ed Herman <br />