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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />it 16. 2018 <br />Jeff Hudak <br />Department Central Services <br />❑ <br />Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />❑ <br />Other: <br />Required Information <br />Company or Vendor Name <br />Jordan Ford <br />New Vendor <br />❑Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE Contractor <br />Requested <br />❑ No ❑ Yes Name of Company <br />Spec D — One (1) or more 2018 or Newer 3/ Ton Four Wheel Drive <br />Project Name <br />Pick Up Trucks <br />Project Number <br />Funding Source <br />2018 Capital Lease <br />Account No. <br />Amount <br />$ 44, 526.00 <br />Terms of Contract <br />Purpose/Description <br />Award Bid <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verify, 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 Original <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />X <br />Jeff Hudak <br />Terri Swift <br />Dispersal After Approval <br />