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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Mav 14. 2018 <br />Jeff Hudak <br />Purchasing ® Michael Schmidt <br />Department Central Services <br />[-1 Agreement <br />LJ Contract <br />L] Proposal U Addendum <br />❑ Professional Services <br />❑ Bid Opening <br />® Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ CIO & PCA No. <br />❑ PCA <br />❑ <br />Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />F-1 <br />Other: <br />Claim <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />McCann Industries, Inc. <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />El ❑ WBE Completed E-Verify.Form Attached 0 Nos <br />Spec K - One (1) or more 2018 or Newer 1.0 Cubic Yard <br />Load ers/Backhoes <br />Project Number <br />2018 Water Works Capital Budget 622-0640-415-43-02 <br />Funding Source <br />Account No. <br />Amount <br />$ 96,421 base. $104,729 base plus Alternates 1,2,3,4,5,6 & 7. <br />Terms of Contract <br />Purpose/Description <br />Award <br />For Chan e.:oMe On <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change: % <br />PO No. <br />Dispersal After Approval <br />Copy Original <br />® ❑ <br />Jeff Hudak <br />® ❑ <br />Ed Herman <br />❑ ❑ <br />