Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/13/2019 <br />Name Marls Dollin er Department SBPD <br />BPW Date 6/25/2019 Phone Extension 7677 <br />Required Prior to Submittal to Board <br />BPW Attorney Lq Attorney Name Clara McDan els <br />Dept. Attorney Z Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item TvDe -. <br />L Professional Services Agreement " Contract <br />Geovanny Martinez <br />El <br />Open Market Contract <br />❑ Amendment/Addendum <br />E] <br />Bid Opening <br />E] Bid Award <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Proposal Opening <br />El C/O & PCA No. <br />Chg. Order, No. <br />❑ Traffic Control <br />E] Other: <br />M quirIT d Information <br />q b All Submissions <br />Proposal IT__ ........... <br />E] Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />E] PCA ' aD� <br />Resolution -#N <br />❑ Ease./Encroach <br />Company or Vendor Name <br />❑ Yes If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />❑❑ <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached Nos <br />Project Name <br />Disposal of obsolete printer/copiers <br />Project Number <br />Funding Source <br />Account No.� <br />Amount <br />_._............__m.._._..._....__......_.._._........................ ..........._.............. _.........._.._............................. <br />Terms of Contract <br />Purpose/Description <br />Requesting board approval to dispose of 6 printer/copiers which are in <br />disrepair, outdated and no longer used by the South Bend Police Department. <br />For Change Orders Oni <br />Amount of <br />Increase $ <br />.........._ .............. ....w.........�....................................... <br />--- ...................................................................._......................................................................................................._............_............................................._Ww <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ �_��................... <br />_...... _._.�m_.ww��......�. <br />Increase <br />% .................. .. .............. ._____.___._ --- <br />Current Percent of Change: <br />Decrease ( <br />%) <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />