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die Todos iniid

City of Nashua Central Purchasing Department
FINANCIAL SERVICES DIVISION

ed Request to Include on Finance Committee Agenda ([] Request to Solicit Bid or Proposal
Date of Request: 11-3-16 4
Proposed Finance Meeting Date: 12-7-16 or Uhl To

Project or Item Title: Cargo van modifications for SRT

Amount: $3,450
Lawson RQ# 9% 47]

Funding Description CERF FY2017 POLICE
Accounting (Finance Committee): TF18_7026_ 81500 CERF50.17.81500

Acctg Unit Acct Sub Acct Activity Acct Category
Requesting Department:
[7 Information Technology (X] Police Department
[_] Engineering (_] Fire Rescue
_] Streets [_] Community Development
L] Traffic (_] Public Health
(_} Park Recreation (] Financial Services
(] Wastewater (J Other
] Solid Waste 1] Other
C1 Library
Are CDBG Funds being used for this iter? [_] Yes XX] No
Is this a time sensitive project? EX] Yes ] No
For Solicit Bid ~ is a list of bidders attached? E] Yes CJ No

Reason for request:

Other supporting comments:

Attach supporting documents (bid document, tabulation, contract, etc.)
Approval Signatures: . Ya
: Bri aren Smith __4 4, Division | f
[ : 1 Date: iy J 4 i 6 fi?

Note: This form will be returned unless fully compieted.