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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 29, 2020 <br />Department Central <br />Name Jeff Hudak Services <br />BPW Date August 11 2020 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name <br />BPW Attorney ® Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />Check the Appropriate <br />Item Type — Required for All Submissions <br />❑ Professional Services Agreement <br />❑ Contract <br />❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award <br />® Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />❑ Resolution <br />❑ Other: <br />❑ Ease./Encroach <br />uired Information <br />Company or Vendor Name <br />New Vendor ❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name Spec C-Two (2) More or Less Custom Rear Mount Pumper <br />Project Number <br />Funding Source Fire Department Lease <br />Account No. 287-09-090-098-445000 <br />Amount $1,000,000.00 <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease ($ <br />BOARD OF PUBLICWORKS <br />Previous Amount <br />$ <br />q.,cit�c <br />Increase' <br />Current Percent of Change: <br />Decrease <br />"al,Presiden+ <br />CJ A Oil <br />Thee c J. Doran, Mcmber <br />New Amount <br />$ <br />Increase�� <br />Total Percent of Change: <br />Decrease <br />Lhzabeih AMaradik, Member <br />Jardan V. Gathers, Member <br />Time Extension Amount: <br />ArITST: <br />New Completion Date: <br />QmisC" an„ <br />Joseph R. Molnar, Member <br />Linda M. Martin, Clcrk <br />