Request to Advertise - Spec O - Two More or Less 2019 or Newer Mid Size Extended Cab Four Wheel Drive Pickup Truck

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 1 /15/16 Name Jeff Hudak Department Central Services BPW Date 1/26/16 Phone Extension 574-235-9316 mmmmivma m rnauammmmouuuuuuuuuuuuuuuuuuuumi�mmuwwmm umwmuowww aim w Rea u i redP...._.._.ri._..........�.... .- or to Submittal to Board Legal F Attorney Name Michael Schmidt Controller El Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ® George King Check the H Agreement ❑ Professional Services Bid Opening ❑ Quote Opening ❑ Change Order No. _ F] Ease/Encroach. ........ .. ther• Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Nropriate Item Tye —Re r for All Submissions Contract [_ Proposal C1 Addendum Resolution ❑ Bid Award ® Req. to Advertise ❑ Title Sheet El Quote Award C/O & PCA No. ❑ PCA Ej Traffic Control Required Information Yes No LJ If Yes, Approved �ymmmPurchasin MBE n WBE ❑ No ❑ Yes Name of Com an Spec O — Two (2) More or Less 2019 or Newer Mid -Siz e Extended Cab Four Wheel Drive Pick Up Truck 2019 Code Enforcement Capital Leasew& Interest .� Lease 612-1201-415.38.01 Interest 612-1201-415.38.02 m,_..........................................�.�.�.�.�.�.�.��.._.......... Bid Opening Date: ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination,. Non -Debarment, E-Verify, Iran, etc. uired For Charge Orders On Amount of Increase $ Decrease $ Previous Amount $ Current Percent of Change: New Amount $ Total Percent of Change: Copy Original ® Jeff Hudak ® F Ron O'Connor ®] Tracy Skibins mm Dispersal After Appo....... .al p Approval