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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/27/18 <br />Name Jeff Hudak Department Central Services <br />BPW Date— 3/13/18 Phone Extension 574-235-93116 <br />Legal <br />Controller <br />Purchasing Z <br />Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Michael Schmidt <br />Check the Appropriate <br />Item Type - RPqvirod,fior All, Subm, ission� <br />F-1 Agreement <br />'"" '' ' <br />F1 Contract El Proposal ❑ Addendum <br />E] Professional Services <br />R Resolution <br />n Bid Opening <br />El Bid Award Z Req. to Advertise Title Sheet <br />E] Quote Opening <br />R Quote Award <br />E] Change Order No. <br />R C/O & PCA No. ❑ PCA <br />F-1 Ease/Encroach. <br />F] Traffic Control <br />❑ Other: <br />Required InformatJon <br />Company or Vendor Name <br />New Vendor <br />El Yes El No E] If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />E] KBE [:1 WBE <br />MBE/WBE Contractor <br />Requested <br />El No El Yes Name of Company <br />Spec E — One (1) or more 2018 or Newer 60'Aer4 Four Wheel <br />Project Name <br />Drive Tower Truck Complete <br />Project Number <br />Funding Source <br />2018 Wastewater Capital Fund 6,42 <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description, <br />Bid Opening Date: <br />Amount of <br />F-1 Required Contractor's Certification Form Attached (Non- <br />' Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />M <br />El <br />El <br />F-1 <br />El <br />El <br />Dispersal After Approval <br />Jeff Hudak & Ken Smith <br />