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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />Auqust 5, 2019 <br />Jeff Hudak <br />Department Central Services <br />BPW Date Au ust 13, 2019 Phone Extension 574-235-9316 <br />Required Prior to Submittal to Board <br />��_. mmITITIT Legal ITmmm ..___... 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 />Check the <br />Agreement <br />El Professional Services <br />Ej Bid Opening <br />Quote Opening <br />E] Chg Order No. <br />Ease./Encroach. <br />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 />iropriate Item Type - <br />0 Contract <br />El Amendment <br />® Bid Award <br />❑ Quote Award <br />El C/O & PCA No, <br />EJ Traffic Control <br />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />uired Information <br />PCA <br />�j Resolution <br />Claim <br />Addendum <br />❑ Title Sheet <br />H Yes LJ If Yes, Approved by Purchasing <br />E No <br />❑ WBE Completed E-Verify Form Attached El es <br />Spec Q — One (1) or more 2019 or Newer 1 Yard Front End <br />Rubber Tire Loader <br />mIT-aste Wate <br />r - Capital ,Lease & Interest <br />750-0630-793.43-02 <br />$101,400.00 <br />For Change Orders <br />Amount of ❑ Increase $ <br />❑ Decrease $ �_.7� ....... _..............�� �_. <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 />❑ Susan Zeeb <br />® <br />❑ Al Greek <br />