HomeMy WebLinkAboutRequest to Advertise - Spec R - One or More 2018 or Newer Combination Jet Rodder Vacuum Machine with Cab & ChassisDate
Name
BPW Date
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
5/10/18
Jeff Hudak
5/22/18
Department Central Services
Phone Extension 574-235-9316
--Required Prior to Submittal to Board
Legal Z Attorney Name Clara M,cDaniels
Controller ❑ Controller review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing Z Michael Schmidt
Check the Appropriate
Item Type — Required for All Submissions I
Agreement
...... . ... . .... ....
n Contract El Proposal Addendum
F-1 Professional Services
0 Resolution
n Bid Opening
❑ Bid Award Req. to Advertise E] Title Sheet
F1 Quote Opening
❑ Quote Award
❑i Change Order No.
F-1 C/O & PCA No. Ej PCA
E] Ease/Encroach.
El Traffic Control
El Other:
Required Information
Company or Vendor Name
New Vendor
0 YesEl INo El If Yes, Approved by Purchasing
MBEANB,E Contractor
❑ MBE [:1 WBE
MBEANBE Contractor
Requested
El NoEl Yes Name of Company,
Spec R — One (1) or more 2018 or Newer Combination Jet
Project Name
RodderNacuum Machine with Cab & Chassis
Project Number
2018 Sewer Department Capital Budget
Funding Source
Account No.
Amount
$
Terms of Contract
Purpose/Description
Bid Opening Date:
n Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.
Amount of
F-1 Increase $ UP
VID
El Decrease $ Ptlilqu wo-as-
Previous Amount $
Current Percent of Change: % MAY 9 o 9CHA I
New Amount
Total Percent of Change: W&C
Dispersal After Approval
Copy
Jeff Hudak
Derick Roberts, Dale Helpingstine, Terri Swift
Original
M
F-1
z
n
F-1
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