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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/23/16 <br />Name Jeff Hudak Department Central Services <br />BPW Date 7/12/16 Phone Extension 574-235-9316 <br />I Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ® Bid Award ❑ Re to Advertise <br />❑ Quote Opening ❑ Quote Award q' Title Sheet <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />F1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Required Information <br />Jordan Motors, Inc. <br />❑ Yes No ❑ If Yes <br />❑ MBE I I WBE <br />Yes Name of Com <br />Pu <br />Spec Y — Four (4) more or less 2016 or Newer Compact Four Door <br />Sedan Automobiles <br />2016 Building Department Capital Lease Principal 600-1306-415- <br />37-11 & Interest 600-1306-415-37-12 (subject to lease funding) <br />66,940.00 ($16,735.00 each) <br />Bid Opening Date: 6/14/16 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination Nnn-np.harmant F_\/o fii Ir,r. -4, <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />❑ <br />❑ <br />For Change Orders <br />Dispersal After Approval <br />Jeff Hudak & Sheila Enos <br />Laura Althoff & Chuck Bulot <br />