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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/6/18 <br />Name Jeff Hudak Department Central Services <br />............. <br />........... <br />BPW Date 11/13/18 Phone Extension 574-235-9316 <br />Required Prior to Submittal to Board <br />E:� ........... ...... .. . . . . .... . <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing Z <br />Check the P <br />H Agreement <br />n Professional Services <br />El Bid Opening <br />El Quote Opening <br />FJ Chg Order No. <br />0 Ease./Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Michael Schmidt <br />Contract <br />te Item Type -,f�qquired foll Submissions F-1 Proposal <br />Z Bid Award El Req. to Advertise <br />F-1 Quote Award <br />El C/O & PCA No. PCA <br />F-1 Traffic Control❑ Resolution <br />t�quirred I r for'm' a t- i on <br />El Claim — <br />Addendum <br />El Title Sheet <br />Hardin s, Inc. <br />...................... ............. <br />El Yes E] If Yes, Approved by Purchasing <br />F, No <br />El MBE Completed E-Verify Form Attached El Yes <br />F-1 WBE EJ No <br />Spec U - One (1) more or less 2018 or Newer Compact Track <br />Loader <br />Street Department - 20206074313801 and 20206074313802 <br />8-9, 140.00 includes all alternates, backup camera and trade in <br />discount. <br />RAVITMOTI-1 on <br />For Chanqe Orders Only <br />. ..... - — -- - ------ - ---------- - ----- <br />Amount of F] increase . ..... <br />F1 Decrease <br />...................... <br />Previous Amount , <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />PO No. <br />Dispersal After Approval <br />Copy <br />Original <br />z <br />Jeff Hudak, Central Services <br />z <br />Terri Swift, Street Department <br />