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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 14, 2019 <br />Name Jeff Hudak <br />Department Central Services <br />BPW Date October 22, 2019 Phone Extension 574-235-9316 <br />HIIIIIHNM <br />fflp[Mff� <br />Rye. Prior to Submittal to Board <br />............ R� <br />. ..... . .......... . . ......... - - - ----- - ............. -= <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller E] and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing M Michael Schmidt <br />Check the <br />H Agreement <br />0 Professional Services <br />El Bid Opening <br />F-1 Quote Opening <br />F-1 Chg Order No. <br />0 Ease./Encroach, <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />iropriate Item _p <br />F-1 Contract <br />El Amendment <br />F-1 Bid Award <br />El Quote Award <br />[:1 C/O & PCA No <br />El Traffic Control <br />Required for All Submissions <br />E Req. to Advertise <br />red Information <br />F-1 PCA <br />F-1 Resolution <br />F-1 Claim <br />Addendum <br />El Title Sheet <br />. .......... .. ...... <br />If Yes, Approved by Purchasing <br />No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />F� WBE El No <br />Spec W — One (1) or More 2019 or Newer 6-Wheeled Motor <br />Grader <br />Street Department Capital Lease & Interest <br />. . ....... . . .. <br />202-0607-431.38.01 & 202-0607-431.38.02 <br />Opening Bid Date: November 26, 2018 <br />Amount of El increase <br />$ <br />El Decrease <br />$ <br />Previous Amount <br />. <br />Current Percent of Change: ............ <br />. ... <br />% <br />New Amount <br />Total Percent of Change: <br />% <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />z <br />E] Jeff Hudak <br />z <br />❑ Terri Swift <br />z <br />can Ward <br />