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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />3/14/19 <br />Jeff Hudak <br />Department Central Services <br />BPW Date March 26, 2019 Phone Extension 574-235-9316 <br />Pdor R�quired tSubmittal <br />...... .. .. . . ..................... ]o al to Board I I I - .....- - --------- - - - <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 Z, <br />Check the A <br />Agreement <br />Professional Services <br />Bid Opening <br />❑ Quote Opening <br />F-1 Chg Order No. <br />F-1 Ease./Encroach. <br />F� 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 />ropdate.Item Type - <br />0"" 't" Contract c Type <br />Amendment <br />Bid Award <br />Quote Award <br />C/O & PCA No. <br />Traffic Control <br />for All Submissions <br />Proposal <br />E Req. to Advertise <br />ired Information <br />E] PCA <br />n Resolution <br />F] Claim <br />rAT ST <br />0 Title Sheet <br />❑ Yes El if Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached El Yes <br />F] WBE El No <br />Spec E - One (1) or more 2019 or newer One -Ton Crew Cab <br />Four Wheel Drive Pickup Truck <br />2019 Sewer Department Cap.it,aI.,,Budget_. <br />#642-0621-415-43-02 <br />Opening Bid Date: April 23, 2019 <br />lgmzlv��� <br />Amount of F1 increase $ <br />El Decrease $ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />Jeff Hudak <br />F1 Terri Swift <br />El <br />n <br />