Laserfiche WebLink
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 />�w�� R uired Prior to Submittal to Board <br />Legal ® 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 />Check the <br />L Agreement <br />❑ Professional Services <br />Bid Opening <br />El Quote Opening <br />EChange Order No. _ <br />Ease/Encroach. <br />Other: Relect Ouunte <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 />roriate Item Tye <br />El Contract <br />❑ Resolution <br />R Bid Award <br />El Quote Award <br />[� C/O & PCA No. <br />Traffic Control <br />for All Submissions <br />I Proposal ❑ Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />Yes II No <br />MBE WBE <br />❑ PCA <br />If Yes„ Approved by Purchas <br />No E Yes Name of Company <br />_— — ..... _... ........ <br />Reject Quote — 4X4 Diesel Utility Vehicle <br />Bid Opening Date:. <br />❑ Required Contractor's Certification Form Attached (Non- <br />Collusion,m Non —Discrimination, Non -Debarment., E-Verif, Iran, etc. <br />uired For <br />i'e Orders Onl <br />Amount of ❑❑ increase <br />Decrease $ _ _ _...�...... <br />Previous Amount <br />Current Percent of Change: <br />New Amount ......_ r . r � "" ". a <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />