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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /6/.1w8w ww....... ._..............� —. <br />Name Jeff Hudak Department Central Services <br />BPW Date 11/13/18 Phone Extension 574-235-9316 <br />,,,,,,,,,,,w, - . w���� <br />Remiu ed Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Z Michael Schmidt <br />Check the <br />Agreement <br />Professional Services <br />E] Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. _ <br />El Ease/Encroach. <br />F] 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 />wrqprate ItemTepe ......v. <br />�] Contract <br />Resolution <br />Bid Award <br />F] Quote Award <br />Fj C/O & PCA No, <br />❑ Traffic Control <br />a ired for All Submissions <br />E] Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />Required Information <br />Selking International <br />MB No ❑ If Yes„ Approved) by Purchas <br />WBE <br />Addendum <br />❑ Title Sheet <br />No ❑ Yes Name of Com an <br />Spec X — Two (2) or wMore 2018 or Newer Swingle Axle Dump Truck <br />2018 Sewer Department Capital Budget <br />............ <br />642-0621-415-43-02 <br />Unit price plus alternates 1, 2 and 4 is $159,308.00. 2 total units <br />will be awarded at the cost of $318,616.00. <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non- <br />Collusion, Non Discrimination, Non -Debarment, E- Verify, Iran, etc. <br />Rulred, F eor Change Orders Only <br />Amount of ❑ Increase $ <br />Decrease $ <br />............_._.. ......... <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % _ <br />Dispersal After mm <br />Approval <br />Copy Original <br />® Jeff Hudak <br />�._........_w-_ .............,.... <br />® j Derick Roberts and Terri Swift <br />.,.............................. . _..........._.....ww__.... ... <br />