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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 16, 2018 <br />Name Jeff Hudak Department <br />Central Services <br />Check the A ro `riate tern T e = Re uired for All:Subm ssrons` <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. ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />II Other: <br />Company or Vendor Name <br />New Vendor <br />MBEMIBE Contractor <br />MBEIWBE 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 />FI <br />Required lnformatora <br />GATES CHEVY WORLD <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />I-1 MBE n WBE <br />❑ No ❑ Yes Name of Company <br />Spec F -- one (1) or more 2018 or Newer Mid -Size Extended <br />Cab Four Wheel Drive Pick Up Truck <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />Jeff Hudak <br />Randv Wilkerson <br />