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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />7/13/16 <br />Department Central Services <br />BPW Date 7/26/16 Phone Extension 574-235-9316 <br />Required Prior to Suhmittal M R nr,i <br />Jeff Hudak <br />Legal ® Attorney Name Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® George King <br />❑ <br />unecK the Appropriate Item Type —Required for All Submissions <br />Agreement ® Contract <br />❑ <br />Professional Services <br />❑ Proposal Addendum <br />❑ Resolution <br />❑ <br />❑ <br />Bid Opening <br />Quote Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />❑ <br />Other: <br />Required Information <br />Company or Vendor Name <br />Kaiser's Auction Service <br />New Vendor <br />❑ Yes ❑ No L If Yes Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor <br />Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Spec — () more or less <br />Project Number <br />Funding Source <br />(subject to lease funding) <br />Account No. <br />Amount <br />$ 5% of proceeds <br />Terms of Contract Auction contract for to sell City vehicles at the Central Services <br />Division. <br />Purpose/Description Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Chance Orders Only <br />Amount of LJ 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 />Dispersal After Approval <br />Sheila Enos, Mary Wisniewski, & Jeff Hudak <br />