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.
