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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />2/25/2019 <br />Jeff Hudak <br />Department Central Services <br />BPW Date March 12, 2019 Phone Extension 574-235-9316 <br />!�dNdlnYi/YH W'A'9YAl/k:1• IMfl <br />C... .. �. � ...__ .... <br />Required Prior to Submittal to Board <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller Ej and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the A <br />" Agreement <br />❑ Professional Services <br />Bid Opening <br />F] Quote Opening <br />�❑ Chg Order No. <br />�] Ease./Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Michael Schmidt <br />Iro (mate„Item y a <br />E Contract <br />Amendment <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No <br />❑ Traffic Control <br />- R9quired forAllSubmissions <br />F-1 Proposal <br />® Req. to Advertise <br />Reauired Information <br />F-1 PCA <br />❑ Resolution <br />n Claim <br />Addendum <br />❑ Title Sheet <br />Yes U If Yes, Approved by Purchasing <br />�] No <br />WBECompleted E-Verify Form Attached Nos <br />Spec C - Two (2) More or Less 2019 or Newer Full Size Cargo <br />Vans <br />2019 Wastewater Capital Budget & <br />2019 Water Works Capital Budget _ <br />642-0630-415-43-02 waste & 642-0640-415-43-02 (water) <br />Opening Bid Date: April 9, 2019 <br />... - . ....... <br />..... <br />Amount of Increase $ <br />Decrease $ <br />....... .__............... <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ ���_....��..........__... �_._._.__...... �_. <br />........................ ..... _....... _ ...._ .... <br />Total Percent of Change: �._.........% <br />..... . .......................... . ....... ..-..... <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />® ❑ Jeff Hudak <br />® Al Greek & Susan Zeeb <br />® �] Roxanne Laws <br />on <br />