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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />December 2. 2019 <br />Jeff Hudak <br />Department Central Services <br />BPW Date December 10, 2019 Phone Extension 574-235-9316 <br />........ ... . . ... <br />_qqqired Prior to Submittal to Board <br />. ........... . . . <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller E] and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing Michael Schmidt <br />Check the Appropriate Item Tvpe — Rem <br />LJ Agreement <br />F-1 Professional Services <br />E] Bid Opening <br />[:1 Quote Opening <br />Fj Chg Order No. <br />n Ease./Encroach. <br />F-1 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 />❑ Quote Award <br />El C/O & PCA No. <br />El Traffic Control <br />�ed for All S.yb.m.is.s.io.n's <br />El Proposal <br />EM MR109MMO <br />E] Req. to Advertise <br />El PCA <br />M Resolution <br />F� Claim <br />Addendum <br />El Title Sheet <br />I I Yes LJ If Yes, Approved by Purchasing <br />F-1 No <br />[] MBE Completed E-Verify Form Attached El Yes <br />F-1 WBE El No <br />Spec V — Two (2) more or less 2019 or Newer Tandem Axle <br />Stainless Steel Multi -Use Dump Trucks <br />2020 Street Department Capital Lease & Interest <br />..... . .... .... ............... — <br />202-0607-431.38-01 & 202,6-0607-431.38-02 <br />....... .............. <br />$472,218.00 mm <br />Amount of Ll Increase <br />Decrease <br />Previous Amount ... <br />.................... Current Percent of Change, <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy Original <br />El Jeff Hudak <br />- — — -------- El Terri Swift <br />.... .. . ... ... _" <br />Sean Ward <br />For C <br />M <br />Dispersal After Approval <br />