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BOARD OF PUBLIC WORI�S <br />AGENDA ITEM REVIEW REQUEST FORM <br />9/14/18 <br />Jeff Hudak <br />Department Central Services <br />BPW Date 9125/18 Phone Extension 574-235-9316 <br />Legal M Attorney Name Clara McDaniels <br />Controller o 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 />LJ Agreement <br />LJ Contract LJ Proposal <br />LJ <br />Addendum <br />F-1 Professional Services <br />F-1 Resolution <br />F1 Bid Opening <br />F1 Bid Award Z Req. to Advertise El Title Sheet <br />F-1 <br />Quote Opening <br />F-1 Quote Award <br />[:1 <br />Change Order No. <br />[:1 <br />C/O & PCA No. E] PCA <br />F-1 Ease/Encroach. <br />F-1 <br />Traffic Control <br />n <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBE/WBE 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 LJ No Ll If Yes, Approved by Purchasi <br />MBE n WBE <br />El No El Yes Name of qpRipany <br />Spec X - Two (2) o" Mor&2018 or Newer Single Axle Dump Truck <br />2018 Sewer Department Capital Budget <br />642-0621-415-43-02 <br />Bid Opening Date: <br />E] Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verb, lran, etc. <br />Amount of El increase $ <br />M Decrease $ <br />Previous Amount <br />Current Percent of Ch <br />New Amount <br />Total Percent of Char <br />Copy Original <br />N F-1 <br />M 1:1 <br />El El <br />