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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 5, 2020 <br />Department <br />Name Jeff Hudak Central 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 /> <br />Dept. Attorney Attorney Name <br /> <br />Purchasing Michael Schmidt <br /> <br />Check the Appropriate Item Type Required for All Submissions <br /> Professional Services Agreement Contract Proposal <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 Opening C/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 N - One (1) or More 2020 or Newer 18,000 lb Four Wheel Drive <br />Project Name Chassis with Custom Flat Bed <br />Project Number <br />Funding Source Water - Cash <br />Account No. 622-06-604-620-445000 <br />Amount $65,000 <br />Terms of Contract Cash <br />Purpose/Description _One (1) Or More 2020 or Newer 18,000 lb Four Wheel Drive Chassis with <br />Custom Flat Bed <br />_______________________________________________________________ <br />_______________________________________________________________ <br />__________________________________________________ <br />For Change Orders Only <br />$ <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 />Increase % <br />Total Percent of Change: <br /> <br />