Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />8/15/16 <br />Jeff Hudak <br />Department Central Services <br />BPW Date 8/23/16 Phone Extension 574-235-9316 <br />Re uired Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller El greater <br />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 ® George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE 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 />Amount of <br />Required Information <br />Crossroads Ambulance Sales & Service, LLC <br />U Yes 12�1 No U If Yes, Approved by Purchasing <br />No ❑ Yes Name of Com <br />Spec AA — Two (2) more or less 2016 or Newer Refurbished Medic <br />Units <br />One (1) 2016 Fire Department Capital Budget 287-0902-422-4302 <br />& One (1) will be funded by the County. <br />165,372.00 Fire Department, $165,372.00 County <br />Bid Opening Date: 7/26/16 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />After Approval <br />Copy <br />Original <br />® <br />❑ Jeff Hudak & Sheila Enos <br />® <br />❑ Todd Skwarcan & Andy Myer <br />❑ <br />❑ <br />