Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />03/05/2019 <br />Jeff Hudak <br />Department Central Services <br />BPW Date 03/12/2019 Phone Extension 574-235-9316 <br />a...-.. n;»,m�uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuumum�,�nmrmwr�r�mm�mimww��w � ,�m� �m�.,��,„�,�y�u„mm�rv�znau„mmMm�mio s. <br />Required Prior to Submittal to Boardn� <br />Legal ® Attorney Name Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® Michael Schmidt <br />Check the A <br />LJ Agreement <br />F1 Professional Services <br />F1 Bid Opening <br />❑ Quote Opening <br />0 Change Order No. <br />El Ease/Encroach. <br />❑ Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of El <br />F] <br />pro rat Item T�pem_- <br />Contract <br />El Resolution <br />Bid Award <br />Quote Award <br />j C/O & PCA No, <br />El Traffic Control <br />for All Subs issro17s <br />Proposal <br />El Req. to Advertise <br />Required Information <br />Jordan Ford <br />Yes ❑ No <br />WBE <br />❑ PCA <br />If Yes, Approved by Purchas <br />Addendum <br />❑ Title Sheet <br />E] No F Yes Name of Compan <br />No <br />p (extension) — One (1) or More 2018 or Newer % Ton <br />Extended Cab Two Wheel Drive Pick Ur) Trucks <br />9 Water Works Capital Bud e�............................................ <br />-w <br />622-0640-415-43-02 <br />$ 76,340.00 including alternates 1,2 & 3 (Quantitym2mvehicles) <br />Award <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination„ Non -Debarment, E-"Verify„ Iran, etc. <br />m ..m.. ..Rewired For Charge Orders Oral .........._... �_ <br />Increase $.m_.. <br />Decrease $ <br />..................................m ... <br />Previous Amount $ <br />. .�_-...._--........ _.....� <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: /o <br />.............. <br />Disp <br />ersal After Approval <br />Copy Original <br />® ❑ Jeff Hudak & Sheila <br />�..�.._.Enos <br />® ❑ Roxane_Lawso.n.& _...A.I —Greek �._.e...�.....�.�.�........... <br />