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W <br />2/19/18 <br />Jeff Hudak <br />MUM I1. <br />Department Central Services <br />BP W Date 2/27/18 Phone Extension 574-235-9316 <br />Required Prior to Submittal to Board <br />Legal Attorney Name Clara McDaniels <br />Controller El 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 Michael Schmidt <br />Check the Appropriate Item Type — Re aired for All Submissions <br />El Agreement F Contract ❑ Proposal ❑ Addendum <br />F-I Professional Services El Resolution <br />Bid Opening, El Bid Award Z Req. to Advertise Title Sheet <br />❑ Quote Opening El Quote Award <br />❑ Change Order No. F C/O & PCA No. ❑ P CA <br />F-I Ease/Encroach. El Traffic Control <br />0 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE Contractor <br />MBENVBE 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 />MOO <br />0 No El Yes Name of Company <br />Spec B — One or More 2018 or Newer Hydraulic Track Excavator <br />Fund 642-0621-415.4302 Motor Equipment <br />0 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non-Discriminiation, Non -Debarment, E-Verifyjj2D, etc. <br />Required For Change Orders Only <br />F-I increase $ <br />Amount of F-I Decrease $ 1"t o <br />Previous Amount work,, <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />M F-I Jeff Hudak <br />F—I Chuck Bulot <br />F-I <br />