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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/2/18 <br />Name Jeff Hudak Department Central Services <br />BPW Date 1019118 Phone Extension 574-235-9316 <br />LJ Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. T <br />❑ Ease/Encroach. <br />I-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEMBE 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 />❑ No ❑ Yes Name of Company <br />Spec W — One (1) more or less 2018 or Newer 3/ Ton Extended <br />Cab Two Wheel Drive Pick Up Trucks <br />2018 Water Works Capital Budget <br />622-0640-415-43-02 <br />$ 38,170 which includes Alternates 1,2 & 3 only. <br />Award <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 />