Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: <br />Name: <br />11/15/2019 <br />Adam Parsons <br />Department: Central Services <br />BPW Date: 11/26/2019 Phone Extension: <br />6W�9TJ9ULM�'I'M'IIIWI' ✓�1&I�J IIIININIWUIN�1114 vm ^/�/FNFGWpk3F%'?4N'�'�Il�p@YiSM1�11flYNNNk6fA➢IW➢ MfM "^1+K"�4(+INNII`�^ 'l+'�-^�"*�2 <br />.....,.�. <br />Required Prior to Submittal to Board <br />�.m.,.....� ............�........ _ _.......� __....�._..w�.W. <br />BPW Attorney X Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />102J <br />Michael Schmidt <br />._ .,.� _ A,... Check the <br />M11! J A u to Item Type — Required br All Submissions <br />Professional Services Agreement Contract <br />❑ Open Market Contract <br />E] Amendment/Addendum <br />Bid Opening <br />Bid Award <br />Quote Opening <br />Quote Award <br />[] Proposal Opening <br />❑ C/O & PCA No. <br />0 Chg. Order, No. <br />❑ 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 />® Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />El Resolution <br />0 Ease./Encroach <br />❑ Title Sheei <br />Kimball Office <br />._.__........._m._._._... ..�.... _... <br />YesE] If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />DCI Cubicles <br />DCI Repair & Maintenance <br />�mm......_....__.._................................................ <br />_...... <br />.� .� ......_. <br />211-1001-460.36-01 <br />$6,737.62..__.. <br />Per State of Indiana QPA <br />Deliver and install additional cubicles in DCI offices <br />For Change Orders Only . _....._ .... _.. <br />Amount of Increase $ <br />Decrease <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease J <br />g V .......... <br />Time Extension Amount: <br />New Comp ate:_............ <br />Completion D �m ... a_ .__ -..... ,- ....._...._................... _ ....... <br />