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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/19/17 <br />Name Dan Buckenmeyer Department DCI <br />BPW Date 12/21/17 Phone Extension X5823 <br />Legal ® Attorney Name Ben 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 <br />® Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />Fl Other: <br />Company or Vendor Name <br />New Vendor <br />Contract <br />❑ Resolution <br />Proposal <br />❑ Bid Award ❑ Req. to Advertise <br />❑ Quote Award <br />❑ CIO & PCA No. ❑ PCA <br />❑ Traffic Control <br />�7�y y rri�- �r r.Y"-,✓r ��-s.,T 4,;'.� .r-'7',�,,,' :r✓;s <br />cokes Development Services, LLC. <br />Yes ❑ No ❑ If Yes, Approved by Purchasing <br />Addendum <br />❑ Title Sheet <br />MBEIWBE Contractor H MBE U WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Professional Services — Pathways Workforce Development <br />Project Number <br />Funding Source EDIT <br />Account No. 408.1001.460.31.06 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />$50,000.00 <br />12 Months -Equal Monthly Installments —Per Attached Contract Terms <br />Consultant/Coordinator for <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment, E-Verifv. Iran, etc. <br />Amount of ❑❑ Increase <br />Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />F" <br />