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HomeMy WebLinkAboutRequest to Advertise - Spec V - Four More or Less 2017 or Newer Mid Size Four Door Hybrid Sedan AutomobilesDate Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM 6/30/17 Jeff Hudak Department Central Services BPW Date 7/11/17 Phone Extension 574-235-9316 ❑ Agreement '❑ Contract U Proposal L 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 I -I 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 Amount of j__.,J Yes j___.J No Lj If Yes, Approved by Purchasing ❑ MBE ❑ WBE ❑ No ❑ Yes Name of Company Spec V - Four (4) more or less 2017 or Newer Mid -Size Four Door Hybrid Sedan Automobiles 2017 Waste Water Capital Budget 642-0630-415-43-02 2017 Fire Department Capital Budget 287-0902-422-43-02 Bid Opening Date: F ] 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: Copy Original ® ❑ Dispersal After Approval Jeff Hudak & Sheila Enos -Al Greek, Ken Smith, Carol Kurzhal Todd Skwarcan