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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/06/2019 <br />........., _. <br />Name Jeff Hudak Department Central Services <br />BPW Date 05/14/2019 Phone Extension 574-235-9316 <br />��� a..vn✓ r <br />Required c u�red Prior to Su ....... <br />Submittal to Board <br />Legal ® Attorney Name Clara I" cDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Michael Schmidt <br />__. ,... <br />Check the <br />G_....0 Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. _ <br />❑ Ease/Encroach. <br />❑ Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBENVBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of El <br />I opriato Item Type — Re �ar <br />Contract <br />Resolution <br />Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Required Inform <br />Yes JJ No A..�,.n� If Yes <br />MBEw..w WBE <br />for All Sub <br />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />roved by Purchasin <br />Addendum <br />❑ Title Sheet <br />❑ No Yes Name of Company_- <br />.. <br />Spec H — Seventeen (17) more or less 2019 or Newer Mid -Size Four <br />Door Hybrid Sedan Automobiles <br />2019 Police Department Lease & Principal Budget <br />2019 Water Works Capital Budget & 2019 Fire Dept. Capital Budget <br />101-0801-411 38.01 & 101-0801-421.38.02 (PD Lease & Interest) <br />5.43 02 (Water) 287-0902-422.43.02 (Water) <br />$ 416,143.00 ($367,185.00 PD)($24,479.00 Fire)($24�„479.00 Water) <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment E-Verify, Iran, etc. <br />Increase <br />Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Rr�s.)uired For , <br />e .$ <br />............................ <br />Orders Onl <br />Dispersal After Appro va l <br />Original <br />❑ Jeff Hudak <br />❑ Renata Matousova, Tim Lancaster <br />❑ Todd Skwarcan, Roxanne Lawson & Al Green <br />