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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />12/15/13 <br />Department Innovation & Tech <br />BPW Date 12/22/16 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 />Mike Sniadecki <br />Purchasing <br />LJ Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />® Other: Purchase over <br />Company or Vendor Name <br />Contract <br />Resolution <br />Bid Award <br />Quote Award <br />C/O & PCA No. <br />Traffic Control <br />Network Solutions. <br />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Legacy Switching Gear Replacement <br />Project Number <br />Funding Source IT Computer Equipment and IT Capital <br />Account No. 404-0672-415-23-25 and 404-0672-415-43-08 <br />Amount $ 125,760.88 <br />Terms of Contract purchase <br />Purpose/Description Replacement of Cisco equipment that is EOL or will be EOL in 2017 <br />Required Contractor's Certification Form Attached (Non- <br />lusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran_ etc <br />Amount of <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />