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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 18, 2019 <br />Name Jeff Hudak Department Central Services <br />BPW Date July 8, 2019 Phone Extension 574-235-9316 <br />PfAIkWUGY6;ukFFf/'fSGM1""A'tiGNG�ItlMIWSWiE�MaYw�IN9AU, IWMGJ�/ri' .. ' q '" WfflffilI . 5^c�mwviiY:YMtt vxicici Y.�uT.�vu'".�u�FNfiVAh11F' W4'HM'n9 11%V'@Atl Y%M INNYDIY.+-�— H <br />Required Prior to Submittal to 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�...-....,,C he�c.k..Wth.e...P <br />L Agreement <br />Professional Services <br />] Bid Opening <br />Quote Opening <br />Chg Order No. <br />❑ Ease./Encroach. <br />N� 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 />yp _ q iropriate Item T e - Required for All Submissions <br />E Contract ❑ Proposal <br />n Amendment <br />Bid Award ® Req. to Advertise <br />El Quote Award <br />El C/O & PCA No. ❑ PCA <br />❑ Traffic Control ❑ Resolution <br />❑ Claim <br />.. R...._....... _ <br />squired Information <br />Addendum <br />❑ Title Sheet <br />...... ....................--­ <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />[_f No <br />[ MBE Completed E-Verify Form Attached El Yes <br />�j WBE No <br />Spec S - One (1) or More Pre -Owned 55' Aerial Bucket Truck <br />Complete <br />Venues, Parks & Arts - Capital Budget .. <br />201-1101-452-43.07 <br />Opening Bid Date: August 16, 2019 <br />..— _-.-------- -.........._ ..... __ nil � ww_�.. . .... ...w .... .... ...._�.............._e........w.�.r ��e Orders 0�.�..ym_ .. ..._..�....�wm...��_��.� <br />Amount of ❑ Increase $ <br />..ew.. <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />..................................... <br />New Amount $ <br />- <br />T <br />otal Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />❑ Jeff Hudak <br />® <br />❑ Ken Glowacki <br />