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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />10/27/16 <br />Michael Sniadecki Department Innovation & Tech <br />BPW Date 11/08/16 Phone Extension 6004 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the Appropriate Item Type — Required for All Submissions <br />® Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />® Professional Services I -I Resolution <br />Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening ❑ Quote Award <br />Change Order No. ❑ C/O & PCA No. ❑ PCA <br />Ease/Encroach. ❑ Traffic Control <br />Other: <br />Company or Vendor Name A-8+ 0,NT- <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBEM/BE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Data Realty -Data Center (Hosting Facility) <br />Project Number n/a <br />Funding Source IT Operating & Professional Services <br />404-0672-415-36-04 (IT Operating) & 404-0672-415-31-06 <br />Account No. Professional Fee <br />Amount $ 705.00 (MRC) — IT Operating & $ 2,020.00 (One Time Charge) - <br />Professional Services <br />Terms of Contract Statement of Work <br />Purpose/Description Data Center -COSB will be using Data Center space to co -locate <br />other locations. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non-Deharment F-VPrifv Iran Pt! <br />Amount of " Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />For Change Orders On <br />Dispersal After Approval <br />Michael Sniadecki <br />