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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />8/17118 <br />Jeff Hudak <br />Department Central Services <br />❑ Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <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 />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 />❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Spec W — One (1) more or less 2018 or Newer 3/ Ton Extended <br />Cab Two Wheel Drive Pick Up Trucks <br />2018 Water Works Capital Budget <br />622-0640-415-43-02 <br />41 <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />