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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />June 18. 2019 <br />Jeff Hudak <br />Department Central Services <br />BPW Date June 25, 2019 Phone Extension 574-235-9316 <br />......... Required Prior to Submittal to Board <br />...... ...... ----- - — --", - ...... ..... . ....... —"-, <br />. ......... <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 Michael Schmidt <br />-------- - ----- <br />Check the Ar)r)ropdate Item Type — <br />p I Agreement <br />F1 Professional Services <br />F-1 Bid Opening <br />F-1 Quote Opening <br />R Chg Order No. <br />F-1 Ease./Encroach. <br />R 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 />Contract — --------- <br />Amendment <br />Bid Award <br />F-1 Quote Award <br />C/O & PCA No. <br />Traffic Control <br />for All Submissions <br />Proposal E] Addendum <br />E Req. to Advertise [:] Title Sheet <br />= fffffl 17, 1 M, M41 I <br />PCA <br />Resolution <br />F-1 Claim <br />L] Yes L] If Yes, Approved by Purchasing <br />F-1 No <br />MBE Completed E-Verify Form Attached El Yes <br />WBE [:] No <br />Spec Q — One (1) or more 2019 or Newer 1 Yard Front End <br />Rubber Tire Loader <br />Wastewater - Capital Lease & Interest <br />. ...... .............. ­— <br />642-0630-415-38.01 & 642-0630-415-38.02 <br />Opening Bid Date: July 23, 2019 <br />For.Chagge 0 Onl <br />F----"' - - - - ----- - --------- - - ----- <br />. . .... ..... . . . ....... y <br />Increase <br />El <br />Amount of 0 Decrease . . . ........ . ........... .......... . ....... <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />........................... <br />Total Percent of Change: <br />Time Extension: <br />Copy Original <br />F-1 Jeff Hudak <br />F-1 Susan Zeeb <br />........... <br />Al Greek <br />Dispersal After Approval <br />