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IN <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE' QUEST FORM <br />12/18/17 <br />Dan O'Connor <br />Department Innovation & Tech <br />BPVV Date 12/21/17 Phone Extension 6201 <br />F- Required Prior to Submittal to Board <br />Legal Z Attorney Name Dougherty/McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller Z and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing Z <br />H Agreement <br />H Contract <br />L] Proposal LJ Addendum <br />F-1 Professional Services <br />0 Amendment <br />[J <br />Bid Opening <br />F-1 Bid Award <br />Req. to Advertise Title Sheet <br />[:1 <br />Quote Opening <br />F-1 Quote Award <br />F-1 <br />Chg Order No. <br />F-1 c/o & PCA No. <br />PCA <br />F-1 Ease./Encroach. <br />El Traffic Control <br />Resolution <br />F1 <br />Other: <br />F] Claim <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />'Terms of Contract <br />Purpose/Description <br />Community Foundation of St. Joe Colunty <br />El Yes El If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached <br />D WBE <br />Donation to Communitv Foundation for Free Wifi <br />IT Services <br />279-0672-415-31-016 <br />$36,426 <br />I For Change Orders Only <br />Amount of F-1 increase $ <br />El Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount , <br />Total Percent of Change: <br />Time Extension: <br />Copy <br />Original <br />F� <br />El <br />9 <br />Santiago Garces <br />Dan O'Connor <br />Shawn Delah <br />El Yes <br />[:] No <br />