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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />3/22/18 <br />Jeff Hudak <br />Department Central Services <br />❑ Agreement <br />❑ <br />Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ <br />Resolution <br />❑ Bid Opening <br />❑ Bid Award ® Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />I] Other: <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />#ion <br />Ll Yes LJ No U If Yes, Approved by Purchasing_ <br />F1 MBE F WBE <br />❑ No ❑ Yes Name of Company <br />Spec N --- Two (2) more or less 2018 or Newer Utility Crew Cab <br />Concrete Trucks <br />2018 Sewer Department Capital Budget <br />I <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount .$ <br />Total Percent of Change: %--- ................ <br />Copy <br />Original <br />❑ <br />❑ <br />Dispersal After Approval <br />Jeff Hudak <br />Derick Roberts, Dale Heloingstine, Terri Swift <br />