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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 11, 2018 <br />Name Jeff Hudak Department Central Services <br />BPW Date May 22, 2018 Phone Extension 574-235-9316 <br />LJ Agreement <br />U Contract LJ Proposal U Addendum <br />❑ Professional Services <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 />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE 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 />GATES CHEVY WORLD <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />F-1 MBE I-1 WBE <br />❑ No ❑ Yes Name of Company <br />Spec H — one (1) or more 2018 or Newer One Ton Four Wheel <br />Drive Pickun Truck Including Animal Transoort Module <br />2018 Animal Control Capital Principal 600-1207-415-4309 <br />Total price - $81,211.00 <br />Award Bid: <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 />Jeff Hudak <br />p/D <br />Dispersal After Approval <br />Randv Wilkerson, Ron O'Connor <br />