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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/2/18 <br />Name Matthew L. Chlebowski Department Central Services <br />Check the Apprapria#e''Item Tvpe - Required forkl Submissions <br />❑ Agreement <br />❑ Contract n Proposal LJ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />n <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE 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 0 <br />Required for <br />Jordan Ford <br />❑ Yes ® No ❑ If Yes, A roved by Purchasing <br />F MBE I] WBE <br />❑ No ❑ Yes Name of Company <br />Spec A — Three (3) More or less, 2018 or Newer Standard AWD 4 <br />Door Utilitv Vehicle <br />1 car from 2017 Building Department Budget Proceeds <br />2 cars from 2018 Capital Lease <br />$ 65,670 <br />Bid Opening Date: <br />❑ 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 />% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Matt Chlebowski, Jeff Hudak, Jen Hockenhull <br />® ❑ Chuck Bulot <br />❑ ❑ <br />