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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 20, 2020 <br />Department Central <br />Name Jeff Hudak Services <br />BPW Date October 27, 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 />Michael Schmidt <br />Check theAppropriate <br />Item T e — Required forAll 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 />Reauired Information <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 />Jordan Automotive Grou <br />❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />Ej ❑ WBE Completed E-Verify Form Attached ❑ No <br />Spec M - Three (3) More or Less 2020 or Newer Front Wheel Drive Cargo <br />Van(s) <br />Water Works -Cash <br />622-06-604-620-445 000 <br />$86,577.00 <br />Cash <br />Three (3) More or Less 2020 or Newer Front Wheel Drive Cargo Van(s) <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 <br />Time Extension Amount: <br />