Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />May2022019.............................._.........................................._W.. <br />Jeff Hudak <br />Department Central Services <br />BPW Date May 28, 2019 Phone Extension 574 235 9316 <br />uur.:m,aanwrvwrrarrrmvevrrwrvrr,`=,�;v.n;m n..-< ,� �: a- �, ... „zr�araw�usa,acm.;m,tiz neuuvuvuvvvHraa ..:.era , ^re�asr... <br />Required _d 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 A <br />LJ Agreement <br />E] Professional Services <br />0 Bid Opening <br />E:] Quote Opening <br />[l Chg Order No. <br />❑ Ease./Encroach. <br />F� Other: <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 />iropriate Item Type — Required for All Submissions <br />Contract ❑ Proposal <br />❑ Amendment <br />® Bid Award ❑ Req. to Advertise <br />Quote Award <br />F] C/O & PCA No. PCA <br />E] Traffic Control Resolution <br />E] Claim <br />,......... Required <br />..Info <br />..... .�....w_� ....� <br />rniation <br />Addendum <br />❑ Title Sheet <br />❑ —Yes ....�....._If _Y...e.....s..,......Ap_p._.r__o_---- v..e....d _b_y......P..66 <br />rchasing _.._....µ <br />No <br />❑F-1 WBE Completed E-Verify Form Attached Yens <br />Spec L — One (1) or More 2019 or Newer Full Size 8-Passanger <br />Van <br />2019 Fire Department Capital Budget <br />287-0902-422.43.02 <br />"� <br />.....— _.... _ ... .................. <br />._........ _.....__ . <br />For Change Orders Only--- .w. �......w...m . ...... <br />Amount of El Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />® ❑ Jeff Hudak <br />® ❑ Todd Skwarcan <br />❑ ❑ <br />