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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />Auaust 5. 2019 <br />Jeff Hudak <br />Department Central Services <br />BPW Date Au ust 13, 2019 Phone Extension 574-235-9316 <br />Required Pnor 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 />Check the A <br />LJ Agreement <br />Professional Services <br />0 Bid Opening <br />(] Quote Opening <br />EJ Chg Order No. <br />F-1 Ease./Encroach. <br />F� 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 />ro r atip Item TyRe- <br />�] Contract <br />El Amendment <br />El Bid Award <br />El Quote Award <br />C/O & PCA No. <br />Traffic Control <br />wired for All Submissions <br />Proposal � ...�.��w..�,m <br />® Req. to Advertise <br />uired Information <br />1:1,1 PCA <br />Resolution <br />H Claim <br />Addendum <br />❑ Title Sheet <br />L Yes U If Yes, Approved by Purchasing <br />N o <br />MBE Completed E-Verify Form Attached ❑ Yes <br />E] WBE ❑ No <br />Spec T — One (1) Or More 2019 or Newer 4x4 Crew Cab <br />Concrete Trucks <br />Sewer Department <br />50-0621-792.43-02 <br />Opening Bid Date: September 10, 2019 <br />..._---- <br />- ----- <br />__..... <br />_ m..�._ <br />For Chn Orders rly mmmmm <br />Amount <br />�..... Decrease increase $ .........._ �� ..... <br />mount of '� <br />_......_.�� ..� _m....,_ <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 />❑ Terri Swift <br />El <br />