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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />2/27/2019 <br />Jeff Hudak <br />Department Central Services <br />BPW Date March 12, 2019 Phone Extension 574-235-9316 <br />�m� n„�r:r�m rwxxr�aarua .. ®u� mm �urwa�uwu�rr�err;�srro✓am�uuuuuuumumumuuuuuuuumu�rerz�w�w.w.rm�,�errr ,, ,ma�wmmwwww.�omo� w.�u�m�a�e�mmmesm�ar�ei��.... . �urc <br />o Board �.. <br />.__.. �.�e. .ee.R uired Prior to Submittal t m . ... <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the <br />] Agreement <br />E] Professional Services <br />'C] Bid Opening <br />Quote Opening <br />Chg Order No. <br />Ease./Encroach. <br />F-1 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 />wContrariate Item T <br />ct <br />Amendment <br />E] Bid Award <br />❑ Quote Award <br />[_] C/O & PCA No <br />0 Traffic Control <br />Required for All Submissions <br />❑Proposal <br />® Req. to Advertise <br />Required Information <br />n PCA <br />E] Resolution <br />I-1 Claim <br />Addendum <br />❑ Title Sheet <br />❑ Yes If Yes, ..... __ ...w_� ..__.... <br />Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />WBE [:] No <br />Spec G — Two (2) more or less 3 Yard Front End Rubber Tire <br />Loaders <br />Water Wormm_mmmmmmmmmks - Capital Budget <br />622-064-041W5-4302 <br />Opening Bid Date: April 9, 2019 <br />for aNe.Orders 0 <br />Amount of increase <br />0 Decrease $ .....�w—.......... <br />_.�......................______............w. <br />Previous Amount $ <br />Current Percent of Change <br />NewAmount_....�.�.�.�.�.�.�.�.�.�................www,�.�A.....�..�.�.�.�...�.�.�.�.�.�.�.�....�.�.......... <br />Total Percent of Change: <br />..��.—_.___.off......_...,—................_...._................ <br />9 ° <br />Time Extension: <br />— Dispersal After Approval <br />Copy Original <br />® ❑ Jeff Hudak_ _ <br />® 1-1Roxanne Lawson & Al Greek..........�.�.�....._.......�_ <br />❑ ❑...�.�.�.�.�.�.�.�.�.�.�.�..____ �....�......�,_ ..u�.._.... <br />