Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /6/18 <br />Name Jeff Hudak Department Central Services <br />BPW Date 11/13/18 Phone Extension 574-235-9316 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the P <br />H Agreement <br />❑] Professional Services <br />Bid Opening <br />❑] Quote Opening <br />I] Chg Order No. <br />EJ Ease./Encroach. <br />M Other: Rewind sward <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Michael Schmidt <br />►riate Item T <br />Contract <br />❑ Bid Award <br />❑ Quote Award <br />ElC/O &PCANo <br />El Traffic Control <br />�Re uq fired for All Si <br />ElProposal <br />❑ Req. to Advertise <br />❑ PCA <br />❑ Resolution <br />n Claim <br />Addendum <br />❑ Title Sheet <br />Rescind the Award to Hill Lift Truck„ Inc. <br />............. <br />❑ Yes F] If Yes, Approved by Purchasing........... <br />❑ No <br />❑ MBE Completed E-Verify Form Attached F] Yes <br />❑ WBE ❑ No <br />Spec U - One (1) more or less 2018 or Newer Compact Track <br />Loader <br />Street Department - 20206074313801 and 20 206074313802 <br />$ $66,709.53 includes all alternates, backup camera and trade in <br />discount. <br />Rescind Award: <br />For Change Orders Only <br />..._ �....� .m ... .... <br />❑ Increase <br />Amount of $ ......_ <br />El Decrease $ <br />Previous Amount _............................. .................................................._...._�....�_ ,gym <br />Current Percent of Change: %�,,,. <br />............................................... _.�....- .............. ..... <br />�..u. ���... <br />New Amount $ <br />Total Percent of Change: % <br />PO No. <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />❑ Jeff Hudak, Central Services <br />®] <br />Terri Swift, Street Department <br />m.�............................................. ........... <br />