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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />June 26, 2018 <br />Jeff Hudak <br />Department Central Services <br />BPW Date July 10, 2018 Phone Extension 574-235-9316 <br />❑ Agreement <br />Lj Contract L] Proposal U Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />n <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE 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 />Gates Toyota <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />F MBE I❑ WBE <br />❑ No ❑ Yes Name of Company <br />Spec P — Two (2) more or less 2018 or Newer Mid -Size Four Door <br />Hvbrid Sedan Automobiles <br />2018 Fire Department Capital Budget 287-0902-422-43-02 <br />$ 25,711 per unit, 2 trade ins at $12,000 per unit. <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment, E-Verifv, Iran, etc. <br />Increase <br />Decrease <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 />❑ Jeff Hudak <br />® <br />❑ Todd Skwarcan <br />® <br />❑ <br />