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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/4/19 <br />Name Jeff Hudak Department Central Services <br />BPW Date 2/12/19 Phone Extension 574-235-9316 <br />• Y �"" """""""VIVD�@'IDH� HUiiNhY2"H✓P, WiC% ✓JU"&'.xAlABb'fiRRMJYY�S 'HgRHRNIf�kW�llN.MP IT�IttI <br />Required Su.... . ................. <br />.___..... <br />.__._........_ <br />Submittal to Board <br />Legal ® Attorney Name Clara McDanelS <br />Controller ❑ 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 />Check the <br />❑I Agreement <br />El Professional Services <br />Bid Opening <br />E Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE 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 />ir9priate Item Typed <br />Contract <br />❑ Resolution <br />Bid Award <br />M Quote Award <br />El C/O & PCA No. <br />Traffic Control <br />for All Submissions <br />wv <br />Proposal ❑ Addendum <br />Ej Req. to Advertise ❑ Title Sheet <br />Required Information <br />Bobcat of Michiana <br />Yes ❑ No [j If Yes <br />f1 MBE _..__.. <br />WBE <br />❑ PCA <br />Purchasi <br />J No aYes Name of Company <br />Ratify Qugte Award - Brush Cutter Compact Excavator <br />2016 E+ uN fn nt Lease Proceeds <br />201-1101-452-4302 <br />$6,451.28 <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Change Orders O alp <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />❑ <br />❑ <br />Jeff Hudak <br />Dispersal After Approval <br />