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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/28/17 <br />Name Sue Gerlach <br />Department IT <br />BPW Date 5/917 <br />Phone Extension 6209 <br />Required Prror to.Submittal to Board <br />Legal ® <br />Attorney Name Michael Schmidt <br />Controller ® <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check <br />the: A <br />ro nate Item T pe ,Required,forAff 8bmrssions <br />❑ Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ <br />CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ <br />Traffic Control <br />M <br />Other: Final cost change <br />Company or Vendor Name <br />Hewlett-Packard <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEIVVBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />HP Schedule 14 <br />Project Number <br />NIA <br />Funding Source <br />IT Lease <br />Account No. <br />279-0672-415-37-11/12 <br />Amount <br />$ -1137.50 <br />Terms of Contract <br />48 Months <br />Purpose/Description <br />Changes in price <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of <br />Increase $ <br />Decrease $ <br />