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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />10/2/18 <br />Jeff Hudak <br />Department Central Services <br />BPW Date 10/9/18 Phone Extension 574-235-9316 <br />❑ Agreement <br />Ll Contract <br />U Proposal LJ Addendum <br />❑ Professional Services <br />❑ Bid Opening <br />® Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />n Other: <br />❑ Claim <br />Company or Vendor Name <br />Hill Lift Truck, Inc. <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />❑MBE ❑Yes <br />MBENVBE Contractor. <br />_ _ _` <br />Completed E�Verify Form Attached <br />❑ WBE - _ ❑ No <br />Spec U - One (1) more or less 2018 or Newer Compact Track <br />Project Name <br />Loader <br />Project Number <br />Funding Source <br />Account No. <br />Street Department - 20206074313801 and 20206074313802 <br />Amount <br />$ $66,709.53 includes all alternates, backup camera and trade in <br />discount. <br />Terms of Contract <br />Purpose/Description <br />Award: <br />Amount of ❑ <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />1 <br />PO No. <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />❑ Jeff Hudak, Central Services <br />® <br />❑ Terri Swift, Street Department <br />❑ <br />❑ <br />