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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 14, 2018 <br />Name Jeff Hudak <br />Department Central Services <br />BPW Date May 22, 2018 <br />Phone Extension 235-9316 <br />Required Prior`to Submittal Ito Board <br />Legal ® <br />Attorney Name Clara McDaniels <br />Controller ❑ <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® <br />Michael Schmidt <br />Check the A <br />ro` riate Item T e - Re "urred:forAll Subirissioris , <br />❑ Agreement ement <br />El Contract ❑Proposal El Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ Change Order No. <br />❑ <br />CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />❑ Other: <br />Requrre611 <br />nformation <br />Company or Vendor Name <br />SelkingInternational <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />New Vendor <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />Spec L - One (1) or More 2018 or Newer 3 1/2 Ton Utility Truck with <br />Project Name <br />Crane <br />Project Number <br />Funding Source <br />Water Works Capital Budget <br />Account No. <br />_2018 <br />622-0640-415-43-02 <br />Amount <br />$ 177,117.32 <br />Terms of Contract <br />Aw.J <br />Purpose/Description <br />g Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required 1=or'Charge Orders nrtly <br />Amount of ❑ increase $ <br />❑ Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Jeff Hudak <br />® ❑ Ed Herman <br />❑ ❑ <br />