HomeMy WebLinkAboutRequest to Advertise - Spec L - One or More 2017 or Newer 3-4 Ton Extended Cab Four Wheel Drive Pick Up Truck�1 77
W t
Date
Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
4/3/17
Jeff Hudak
Department Central Services
H
Agreement
U Contract L Proposal LJ Addendum
❑
Professional Services
❑ Resolution
❑ Bid Opening
❑ Bid Award ® Req. to Advertise ❑ Title Sheet
❑ Quote Opening
❑ Quote Award
❑
Change Order No.
❑
CIO & PCA No. ❑ PCA
❑
Ease/Encroach.
❑
Traffic Control
n
Other:
Company or Vendor Name
New Vendor
MBE/WBE Contractor
MBEIWBE Contractor
Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Amount of
U Yes LJ No L If Yes, Approved by Purchasing
❑ MBE ❑ WBE
❑ No ❑ Yes Name of Company
Spec L — One (1) or more 2017 or Newer 3% Ton Extended Cab
Four Wheel Drive Pick Up Truck
2017 Venues, Arts, & Parks Capital Lease 201-1101-452-37-11 &
Interest 201-1101-452-37-12 (subject to lease funding)
$
Bid Opening Date:
❑ Required Contractor's Certification Form Attached (Non -
Collusion. Non -Discrimination. Non -Debarment, E-Verifv. Iran. etc.
❑ increase $
❑ Decrease $
Previous Amount
Current Percent of Change:
New Amount
Total Percent of Change: %
Dispersal After Approval
Copy Original
® ❑ Jeff Hudak & Sheila Enos
® ❑ Cecil Eastman & Paul Moreland