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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/4/19 <br />.......................... ................... _............................ ............._.__ _ ............... <br />Name Jeff Hudak Department Central Services <br />BPW Date 2/12/19 Phone Extension 574-235-9316 <br />aim �imimimi�r mxe iuwu immmmwr+,zrdrr� ,,.�.... <br />y Submittal to Board <br />......__..._ ........ .� ..................___..w�.._ a wired Prior to Su _.�..... �..�.�.�........�mm.._ .. _mm_...-�� .....�..._ <br />Legal Z Attorney Name Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Michael Schmidt <br />14 <br />❑ Agreement <br />[� Professional Services <br />Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. _ <br />El Ease/Encroach. <br />F] Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />prop iat ...Item Ty e `: <br />F] Contract <br />❑ Resolution <br />❑ Bid Award <br />® Quote Award <br />❑ C/O &PCANo. <br />_ <br />D Traffic Control <br />moor All Submissions <br />fissions <br />Proposal Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />Bobcat of Michiana <br />El <br />Yes [:1 No ❑ If Yes <br />MBE F� WBE <br />❑ PCA <br />ADDroved by Purchasin <br />❑ No ❑ Yes Name of Comp N <br />Ratify Quote Award — Compact Excavator <br />2016 Equipment Lease Proceeds <br />�._ ..... - ....................... <br />201-1101-452-4302 <br />$ 9 W yq( Slq . -7P, <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment -Verify, an, �.._... <br />-Re—quired For Change Orders Obiy <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: . ............. <br />New Amount $ <br />Total Percent of Change:........... <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />[� Jeff Hudak <br />a................................ <br />