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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />5/14/18 <br />Jeff Hudak <br />Department Central Services <br />❑ Agreement <br />U Contract a Proposal LJ 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 />C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />I-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBEIWBE 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 />Jordan Ford <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />F-1 MBE n WBE <br />❑ No ❑ Yes Name of Company. <br />Spec N — Two (2) more or less 2018 or Newer Utility Crew Cab <br />Concrete Trucks <br />2018 Sewer Department Capital Budget <br />$117,270 total for 2 trucks. $58,635 per truck <br />Arvar J <br />g 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 />Dispersal After Approval <br />Copy Original <br />® ❑ Jeff Hudak <br />® ❑ Derick Roberts, Dale Helpingstine, Terri Swift <br />❑ ❑ <br />