Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/30/18 Y <br />Name Michael E. Sniadecki Department Innovation & Tech <br />BPW Date 9/11/18 Phone Extension 6004 <br />Company or Vendor Name <br />Graybar <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEMIBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />City of South Bend UPS Addition/Replacement - Graybar <br />Project Number <br />nla <br />Funding Source <br />IT Supplies/Purchases <br />Account No. <br />279-0672-415-21-05 (IT Supplies/Purchases) <br />Amount <br />$9,381.19 <br />Terms of Contract <br />Quote <br />Purpose/Description <br />Repiacing /q Adding 5 UPS Batteries, <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Nan -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />'' � , � sA,_Re oared <br />�ot-`Chan e Orders Onl " <br />❑ Increase $ <br />Amount of <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 />® ❑ Michael <br />Sniadecki <br />❑ ❑ <br />❑ ❑ <br />