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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 5, 2020 <br />Department Central <br />Name Jeff Hudak Services <br />BPW Date October 13, 2020 Phone Extension <br /> <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br /> <br />Purchasing Michael Schmidt <br />Check the Appropriate Item Type – Required for All Submissions <br />Professional Services AgreementContractProposal <br />Open Market Contract Amendment/Addendum Special Purchase, QPA <br />Bid Opening Bid Award Req. to Advertise Title Sheet <br />Quote Opening Quote Award Reject Bids/Quotes <br />Proposal OpeningC/O & PCA No. PCA <br />Chg. Order, No. Traffic Control Resolution <br />Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE Yes <br />MBE/WBE Contractor Completed E-Verify Form Attached <br />WBE No <br />Spec L - Two (2) More or Less 2020 or Newer ¾ Ton Four Wheel Drive <br />Project NamePick Up Trucks <br />Project Number <br />Wastewater – Cash <br />Funding Source Water Works – Cash <br />Wastewater: 642-06-605-514-445000 <br />Account No. Water Works: 622-06-604-620-445000 <br />Amount Wastewater -$40,000 <br />Water Works - $90,000 <br />Terms of ContractCash <br />Purpose/Description_Two (2) More or Less 2020 or Newer ¾ Ton Four Wheel Drive Pick Up <br />Trucks_________________________________________________________ <br />_______________________________________________________________ <br />________________________________________________________ <br />For Change Orders Only <br />$ <br /> Increase <br />Amount of <br /> Decrease ($ ) <br />Previous Amount$ <br />% <br />Increase <br />Decrease ( %) <br />Current Percent of Change: <br /> <br />New Amount $ <br /> <br />