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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/5/18 <br />Name Sue Gerlach Department IT <br />Purchasing <br />LJ <br />Agreement <br />U Contract U Proposal U <br />Addendum <br />❑ <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 />❑ C/O & PCA No, ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />M <br />Other: Lease Schedule <br />Company or Vendor Name HP <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name HP Lease Schedule 17 <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Previous Amount <br />N/A <br />IT Lease <br />Principal 279-0672-415-37.11 and Interest 279-0672-415-37.12 <br />$9092.00 <br />$193.50/Month for 48 months <br />HP Lease Schedule <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />f, ..Required ForChange Oilers Otiy . <br />increase $ <br />Decrease $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />11 <br />