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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM I?EVIEW RE' QUEST" FORM <br />12-13-17 <br />Santiaao Carces <br />Department Innovation <br />BPW Date 12-21-17 Phone Extension 7652 <br />Legal Attorney Name Dougherty, <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 />❑ Agreement ❑I Contract Proposal L ] Addendum <br />Professional Services ❑ Resolution <br />Bid Opening El Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />El Quote Opening ❑ Quote Award <br />Change Order No. ❑ C/O & PGA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />F 1 Other: <br />Company or Vendor Name Claremont Grady <br />New Vendor ❑ Yes M No [ <br />MBE/WBE Contractor [] MBE 0 WBE <br />MBEANBE Contractor (Requested ❑ No I Yes <br />Project Name <br />Project Number <br />If Yes, Approved by Purchasing <br />Name of Company <br />Funding Source IT Fund Professional Services <br />Account No. 404-0672-415-31-06 <br />Amount $ 5,000 <br />Terms of Contract 1 /1 /2016--12/31 /2018 <br />Purpose/Description Professional Services for Drucker LifeLong Learning Initiative <br />Z' Required Contractor's Certification Farris Attached (Non - <br />Collusion, Nan -Discrimination, Non -(Debarment, E-Verify, Iran, etc.' <br />Amount of H 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 Original <br />FI Santiago Oarces <br />Shawn Delahanty <br />❑ Dan O'Connor <br />