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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 2, 2019 <br />Name Jeff Hudak <br />Department Central Services <br />BPW Date Ma 14, 2019 Phone Extension 574-235-9316 <br />W,`Ml � ��� NNN�DYrk�dMN�'M�'M������'9YMWMGMIWMHdfg9ll/Al/ JWBpWf'd9'�k'� N'YN �..: + ..., r R ���� ���IiuIYnIIIIflIIR61HA;AAO�.. <br />Requiredal to Board oard <br />!....Pnor to Subm.........!�.................................�.�......�.. <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.J Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />0 Quote Opening <br />Change Order No. _ <br />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 />►ro riate Item Tempe — e <br />❑ Contract <br />n Resolution <br />El Bid Award <br />[] Quote Award <br />F] C/O & PCA No. <br />❑ Traffic Control <br />d for All Submissions <br />Proposal <br />® Req. to Advertise <br />Required Information - <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Yes L J No LJ If Yes,mmA proved by Purchasin <br />MBE] WBE <br />❑ No ❑ Yes Name of Company m <br />�.........._._ _......._6 <br />IT Spec K — One (1) or More 2018 or NewerUtility Work Machine ........._... <br />2019 Venues, Parks & Arts Capital Budget <br />406-1101-452.42-01 <br />Bid Opening Date: May 14, 2019 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion„ Non -Discrimination, Non -Debarment, E-Verif)r, mI n„ etc. <br />Reqiuiredl For Change Ord __.._. W_..Y._.�...,..,�,.�m m........._.�_�.. <br />rs Only <br />Amount of El Increase <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Dispersal After Approval <br />p pp ovall <br />Copy <br />Original <br />® <br />❑ Jeff Hudak <br />