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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: <br />Name: <br />10/31/2019 <br />Adam Parsons <br />Department: Central Services <br />BPW Date: 11/7/2019 Phone Extension: 9302 <br />wrr�n a wrvnu ru; remra;;��rr, � ifl�rmvrvnviwu„ cur+ war rmwrt w�. +e m�ra �r v2=901 HW�Trivr mervnmm�mri� ..� <br />Re uired Prior to Submittal to Board <br />.... BPW Attorney <br />�._.� ............ �.�.,�. �........ <br />rney X Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing ® Michael Schmidt <br />Check the <br />ate Item Ike - Requit-ed.16r All Submissions <br />LJ Professional Services Agreement F-1 Contract <br />[� <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening ❑ Bid Award <br />❑ <br />Quote Opening ❑ Quote Award <br />R <br />Proposal Opening ❑ C/O & PCA No. <br />❑ <br />Chg. Order, No. ❑ Traffic Control <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 />Information <br />Proposal <br />N Special Purchase, QPA <br />El Req. to Advertise <br />Reject Bids/Quotes <br />E] PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />Kimball Office <br />mmmmmmµWWW If Yes Approved b Purchasing <br />-_.� ----- <br />Yes[:] ............. <br />❑ � pp Y sing <br />® No <br />MBE Completed E-Verify Form Attached ❑ Yes <br />F WBE ❑ No <br />DCI Cubicles <br />DCI Repair & Maintenance <br />211-1001-460.36-01 <br />$37,861.33 <br />Per State of Indiana OPA <br />Deliver and install cubicles in DCI offices <br />Chan $e Orders Only <br />Amount of El Increase $ <br />m.�_.. <br />Decrease mm $ <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease %) <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease 0 <br />g <br />Time Extension Amount: <br />New Completion Date: <br />