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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />October 12, 2018 <br />Roger Nawrot <br />Purchasing <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />Contract <br />❑ Resolution <br />Department <br />Division/Bureau <br />Proposal <br />Public Works <br />Engineering <br />❑ Bid Award ❑ Req. to Advertise <br />❑ Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control: <br />New Vendor <br />MBENVBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Addendum <br />❑ Title Sheet <br />Yes M No If Yes, Approved by <br />Purchasina <br />U MBE Lj WBE <br />❑ No ❑ Yes Name of Company <br />6777 Enterprise Drive <br />Light Up South Bend - COIT <br />404-0602-431.31-06 <br />$17,232.64 <br />Terms of Contract Lump Sum <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />rsal After <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />