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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 17, 2019 <br />Name Jeff Hudak Department Central Services <br />W Date Set ember 24, 2019Phone Extension 574-235-9316 <br />IBIPdI�dYs9JNu;CllYC4A'"#&R"'aVBYF�iX'RnIM�V 'W¢4's:�Y k'SP.P:NJ1r";3'I" `Y�5'�vAYl.,a� +vz�mmc�Pr. ,,"N6✓84Y.�5k'W'iYWkiW'NNY:kfl��'F M1!fi!M rfNi lkWKKr"J0.W1rvtlN,rYr�H.'+� <br />��............�...... . ..... ...........wwwww�. _.,.._ _.___.,.,.,., .... .m . .........gym � ..,...,a,...d...,. _._.......__._....,..,,,,, <br />Re uired Prior to Submittal to Board <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller [J and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the <br />Agreement <br />Professional Services <br />j Bid Opening <br />Ej Quote Opening <br />[-] Chg Order No. <br />El Ease./Encroach. <br />F� Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Michael Schmidt <br />lropriate Item Type — <br />❑ Contract <br />Amendment <br />El Bid Award <br />El Quote Award <br />El C/O & PCA No, <br />Traffic Control <br />or All Sub.... ns <br />Proposal <br />® Req. to Advertise <br />uired Information <br />PCA <br />Resolution <br />Claim <br />Addendum <br />❑ Title Sheet <br />Yes E If Yes, Approved by Purchasing <br />F1 No <br />E] MBE Completed E-Verify Form Attached El Yes <br />[� W B E [-] No <br />Spec V — Two (2) More or Less 2019 or Newer Tandem Axle <br />Stainless Steel Multi -Use Dump Truck <br />t Street Department Capital Lease & Interest <br />202-0607-431.38.01 & 202-0607-431.38.02 <br />Opening Bid Date: October 22, 2019 <br />Amount of ❑ Increase <br />$ <br />Decrease <br />$ <br />Previous Amount..-�._..�.�_—..................................................�.��.� <br />�.�.�........ <br />Current Percent of Change: <br />.............�.�......�.� ............. .m............... <br />% <br />...........__..__..— <br />New Amount $ <br />....................—.......—w <br />Total Percent of Change:.�..�_m.—.%.....�..�...�.�.�.�.� <br />..............�.�.�.�................ w�ww <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />�] Jeff Hudak <br />F ]I Terri Swift <br />❑ � S ... �. <br />Sean Ward <br />