Award Quote - Four Winds Field Water Softener - Culligan Water

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Name 05/23/2019 Patrick Sherman Department VPA BPW Date 05/28/2019 Phone Extension 5601 wmmmwrvmu wmuuoo mwm wwi�tirem �atiumxu�uu WN emm moon red Prior to Submittal to Board Legal Z Attorney Name Clara McDaniels Controller z Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing Z Michael Schmidt Check the Agreement El Professional Services ❑ Bid Opening ❑ Quote Opening 0 Change Order No.. El Ease/Encroach. Other: �rqp iate Item T r , El Contract Resolution El Bid Award ® Quote Award F] C/O &PCANo, E] Traffic Control )r All Submissions Proposal E] Req. to Advertise �d Information Company or Vendor Name Culligan of Mishawaka ❑ PCA Addendum ❑ Title Sheet New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE 0 WBE MBE/WBE Contractor Requested ❑ No [:] Yes Name of Company Project Name Four Winds Field Water Softener Project Number . w_.... .... ............................... ----- 1083-2019 Funding Source Non-revertina Cove fund ,,,, ......................... Account No. 401-1101-452.36.09 Amount $ 13,325.0�.�............_..� �ww �....... �..............�_...__ ........ 0 Terms of Contract 30 days from NTP ...... ............................ _.w.... Purpose/Description Project Completion Affidavit Required Contractor's Certification Form Attached (Non - ............. Collusion, Non -Discrimination, Non -Debarment,, E-Verify, , Iran, etc. Required; For Charge Orders Only Amount of ❑ Increase $ Decrease $ Previous Amount $ Current Percent of Change: 0% New Amount .................. Total Percent of Change: .0%...... Dispersal After Approval Copy Original ❑ ❑ ❑ ❑ ❑ ❑