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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/4/19 <br />............ _........_.................... <br />Name Jeff Hudak Department Central Services <br />BPW Date 2/12/19 Phone Extension 574-235-9316 <br />Required Prior to Submittal to Board <br />Legal ..�� �. Attorney Name Clara McDanMels <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 Michael Schmidt <br />Check the <br />Agreement <br />Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Change Order No. <br />El Ease/Encroach. <br />0 Other: <br />�ropr!ate Ite_m.Te <br />Contract <br />Resolution <br />❑ Bid Award <br />® Quote Award <br />�C/O &PCANo. <br />Traffic Control <br />for All Submissions <br />Proposal Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />❑ PCA <br />Company or Vendor Name The Kennel Corporation <br />New Vendor .-- Yes 0 No If Yes Approved by Purchasin <br />MBE/WBE Contractor MBE ❑' WBE <br />�_._._..........._ ........ ...... ... __....................................... <br />MBE/WBE Contractor <br />Requested ❑ No ❑ Yes Name . <br />............ .... � <br />Project Name Ratify Quote Award — Sand Pro 3040 <br />_....... ................... <br />Project Number 2016 Equipment Lease Proceeds <br />Funding Source 201-1101-452-430 _._........................._ ...... ......... ........ .._ <br />Account No. <br />............................... — __ _. ...... <br />Amount $47,566.76 <br />Terms of Contract <br />Purpose/Description Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion Non -Discrimination, Nown-D b rment, E Verner, Iran, etc.. <br />RecIyut0..fo qhpnqe. rdu rs OnI <br />Amount of Increase -$ <br />E Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy Original <br />® ❑ Jeff Hudak <br />® ❑-..— ..............................m <br />El 1-1 <br />° <br />............... <br />Dispersal After Approval <br />