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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/06/2019 <br />Name Jeff Hudak_ <br />udak <br />. <br />� Department Central Services <br />BPW Date 05/14/2019 <br />Phone Extension 574 235 9316 <br />, ., .,< <br />.:a,✓✓ ,m roe. ... rrrcvatinmr,.Kimnrar: , earn, ....eiio. <br />Ro gUir Prior to Submittal to Board <br />Legal <br />g <br />m __ .... wa. <br />Attorney Name Clara McD ls <br />� <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller [TIT] <br />;and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Michael Schmidt <br />- ropri, to Item Type e uired for All SubmIsIs on"s ... m <br />ec t e A <br />d Agreement <br />� � ,,;._.... <br />d . Contracts Proposal d Addendum <br />[ ]' Professional Services <br />0.„ Amendment <br />Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />[J Quote Opening <br />❑ Quote Award <br />[A Chg Order No. <br />❑ C/O & PCA No, PCA <br />E] Ease./Encroach <br />Traffic Control Resolution <br />.. ....Other: <br />C Claim <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 />ired Information <br />I❑ Yes [ - If Yes, Approved by Purchasin <br />g <br />El No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />Spec C — Two (2) More or Less 2019 or Newer Full Size Cargo <br />Vans <br />2019 Wastewater Capital Budget & <br />2019 Animal Control Capital Budget <br />642-0630 415 43 02 Waste 600-1207-415.43.02 Animal <br />($31,496 0 .. s _ (.......... <br />O Waste)($60,224.00 Animal) <br />$61,720 00 _ <br />Opening Bid Date: <br />For Change Orders On <br />Amount of L ...� Increase $ <br />El Decrease $� <br />Previous Amount �� <br />_..... -- <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />El Jeff Hudak <br />® <br />❑ Ron O'Connor <br />® <br />❑ Roxanne La wson <br />