HomeMy WebLinkAboutRequest to Advertise - Eighteen (18) More or Less New Heavy Duty Mobile Lifting Systems( -_ a -. 'I Y
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BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
Name
5/31 /17
Jeff Hudak
Department Central Services
BPW Date 6113/17 Phone Extension 574-235-9316
Legal ® Attorney Name Michael Schmidt
Controller ElController review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing ® George King
❑
Agreement
❑ Contract ❑ Proposal ❑ 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
F�
Other:
Company or Vendor Name
New Vendor
MBE/WBE Contractor
MBE/WBE Contractor
Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
LJ Yes U No U If Yes, Approved by Purchasing
n MBE n WBE
❑ No ❑ Yes Name of Company
Spec T — Eighteen (18) more or less New Heavy Duty Mobile Lifting
Systems
2017 Central Services Capital Budget
224-0605-419-43-10
Bid Opening Date:
❑ Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.
Amount of ❑ Increase $
❑ Decrease $
Previous Amount $
Current Percent of Change: %
New Amount $
Total Percent of Change: %
Dispersal After Approval
Copy
Original
®
❑
®
❑
®
❑
Jeff Hudak
Sheila Enos
Wisniewski