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BOARD OF PUBLIC WOR.JkS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12-18-17 <br />Name Dan O'Connor <br />Department Innovation <br />BPW Date 12-21-17 Phone Extension 7652 <br />Legal Attorney Name Dougherty <br />Controller z 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 z <br />Lj Agreement <br />H Contract Lj Proposal L] Addendum <br />Z Professional Services <br />F-1 Resolution <br />R Bid Opening <br />Ej Bid Award El Req. to Advertise E] Title Sheet <br />F-1 Quote Opening <br />F] Quote Award <br />Ej <br />Change Order No. <br />R C/O & PCA No. PCA <br />El <br />Ease/Encroach, <br />R Traffic Control <br />R <br />Other: <br />Company or Vendor Name <br />Brian Donoghue <br />New Vendor <br />0 Yes M No ❑ If Yes, Approved by Purchasing <br />MBENVBE Contractor <br />F-1 MBE F-1 WBE <br />MBENVBE Contractor Requested 0 No F-1 Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />IT Fund Professional Services <br />Account No. <br />404-0672-415-31-06 <br />Amount <br />$20,000 <br />Terms of Contract <br />1/11/2018 — 3/31/2018 <br />Purpose/Description <br />Professional Services for Innovation & Technology Initiatives <br />0 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of H Increase $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />M E] Santiago Garces <br />M F] Shawn Delahanty <br />M F-1 Dan O'Connor <br />