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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2017-02-24 <br />Name Rene Casiano Department Office of Innovation <br />BPW Date 2017-03-14 Phone Extension 5897 <br />I 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 ❑ 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 />Information <br />Company or Vendor Name AMCS Group, Inc. <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 Route Planner module <br />Project Number <br />Funding Source <br />Account No. 61l.n(./o_ii. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />3 years or when we sign a comprehensive ELEMOS agreement <br />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 />Required Contractor's Certification Form Attached (Non- <br />usion, Non -Discrimination, Non -Debarment. E-Verifv. Iran. et( <br />Dispersal After Approval <br />