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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />December 11, 2019 <br />Jeff Hudak <br />Department Central Services <br />BPW Date December 19, 2019 Phone Extension 574-235-9316 <br />Rqq_41red Prior 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 />C hprk <br />L_J Agreement <br />F-1 Professional Services <br />[] Bid Opening <br />El Quote Opening <br />�j Chg Order No. <br />El Ease./Encroach. <br />[7 Other: Purchase <br />Z Michael Schmidt <br />bropriate Item jype- <br />Contract <br />Amendment <br />Bid Award <br />❑ Quote Award <br />C/O & PCA No. <br />Traffic Control <br />!qyi+a for All S, <br />[:] Proposal <br />[:] Req. to Advertise <br />'Required Information <br />Company or Vendor Name Advantage Ford <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 />Z Yes E <br />[:] No <br />F-1 RAPP: <br />El PCA <br />[:] Resolution <br />F-1 Claim <br />If Yes, Approved by Purchasing <br />E] WBE Completed E-Verify Form Attached <br />2020 F250 4X4 <br />Wastewater Capital Budget <br />....................�642-0630-415-43-02 <br />0 93.72 <br />................ <br />Addendum <br />El Title Sheet <br />Far <br />7-77; <br />Orders, n <br />. . .. .. . <br />Amount of F-1 increase $ ... . ........... . ......... <br />F Decrease <br />Previous Amount <br />Current Percent of Change:..........._....... <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy Original <br />F-1 Jeff Hudak <br />. ................. . ... <br />Susan Zeeb <br />. ........................................ <br />F-1 Al Greek <br />Dispersal After Approval <br />El Yes <br />[:] No <br />