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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/31/19 <br />Department Central <br />Name Michael Schmidt/Ben Dougherty Serv.i.ces/Adm!nFi .......,�- — <br />.— <br />BPW Date March 12, 2019 Phone Extension 574-235-9977 <br />IIIXII drfiVNFttFM1dWdRdY�VttVb,YCYNKk+�mr�m-maNNrkN,'11�:'.'hR(Ak1YX1@W�VNR'IRP.VIRAP.VIRNRAMV1�1Vfv������iiad�sn:+.-;K' �dfUl. :u�e' V1M�M�Mrv�NY��ImIONA�rht11�M�+^!s".uiiyPdGiBO�k'6�IrAW�W'NfNfmN NVXIR�k��a' u-va.. g.,?A"%'EVbJA'Nli <br />..,..,.. .. .m ..�,.. .......,_..__� ......, ........... _....... .... .... .. ..____. _ <br />�..... Required Prior to Submittal to Board _._..mm ----- <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 <br />L, Agreement <br />Professional Services <br />Bid Opening <br />El Quote Opening <br />❑ Chg Order No. <br />Ease./Encroach. <br />17 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 />Amount of <br />Michael Schmidt <br />rropriate ltem.Ty <br />Contract <br />Amendment <br />Bid Award <br />El Quote Award <br />[:1 C/O & PCA No, <br />❑ Traffic Control <br />ired for All Submissions <br />...— ------------ .------ .--_. <br />Ej Proposal ❑ Addendum <br />® Req. to Advertise ❑ Title Sheet <br />Required Information <br />E PCA <br />❑ Resolution <br />F—N Claim <br />...Yes .- E] If Yes, A..... d........ �...__�_�.�..........................Y-__ _.�....... <br />pprove� by Purchasing <br />No <br />MBE Completed E-Verify Form Attached El Yes <br />�] WBE ❑ No <br />RFQ — Print Shop Services <br />All City Departments <br />Explore potential relationship with 3rd Party Print Service <br />company <br />Opening Bid Date: J <br />_..,— my 9 2019 <br />Incr���� <br />Dec <br />Previous Amount <br />Current Percent of Change; <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy Original <br />® El <br />El <br />Dispersal After Approval <br />Michael Schmidt, Matt Chlebowski, Ben Douqhe <br />I - <br />