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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />4/04/2019 <br />Jeff Hudak <br />Department Central Services <br />BPW Date May 28, 2019 Phone Extension 574-235-9316 <br />arv�vwrinrm�xw�r��wrt� ,,.�,� � m�r�mmuuuuuuuummwwuwwwwmwwwwwwwwwww�mwwwwuurc�wvmowe�a,�uwnmro� ��rv�a�ur�aama� <br />Pnor to Submittal t... <br />�. <br />.� o Board.... _. —.....- <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 />m Check the A <br />LJ Agreement <br />0'' Professional Services <br />E] Bid Opening <br />E] Quote Opening <br />0 Chg Order No. <br />❑ Ease./Encroach. <br />El 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 />rro pq — Rql <br />El Contract <br />❑ Amendment <br />El Bid Award <br />Fj Quote Award <br />C/O & PCA No. <br />Traffic Control <br />w <br />for All Submissions <br />ProposalAddendum <br />® Req. to Advertise ❑ Title Sheet <br />❑ PCA <br />If Resolution <br />III Claim <br />U Yes U If Yes, Approved by Purchasing <br />❑ No <br />F-1 MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />Spec M — One (1) or More 2019 or Newer Combination Jet <br />Rodder/Vacuum Machine with Cab & Chassis <br />2019 Sewer Department Capital Bud <br />642-0621-415-43-02 <br />Opening Bid Date: May 28, 2019 <br />.w_ <br />_.. t.... <br />increase $ ........................... ... <br />$ Dec.rease......._......... ______�.........�....v..�. �. <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 />® <br />Jeff Hudak <br />® <br />TerriSwift <br />i <br />w ft ftEl <br />........... <br />