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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 25th 2018 <br />Department Innovation and <br />Name Brian Donoghue Technology <br />BPW Date May 8th 2018 Phone Extension <br />Required Prior to Submittal to Board <br />Legal Attorney Name <br />Controller review is required for all' Contracts $5,000,00 or more <br />Controller El and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F-1 <br />L] Agreement <br />N Contract <br />El Proposal El Addendum <br />Z Professional Services <br />El <br />Amendment <br />F-1 Bid Opening <br />El <br />Bid Award <br />El Req. to Advertise E] Title Sheet <br />F-1 Quote Opening <br />F-1 <br />Quote Award <br />E:1 <br />Chg Order No. <br />n C/O & P'CA No. <br />PCA <br />0 <br />Ease./Encroach, <br />F] Traffic Control <br />F-1 Resolution <br />F1 <br />Other: <br />n <br />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 />Pemberton and Davis <br />❑ Yes E:11f Yes, Approved by Purchasing <br />No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />F-1 WBE 0 No <br />Diqital Access Sites <br />Department of Innovation and Technology Professional Services <br />279-0672-415-31-06 <br />$2268.00 <br />Purpose/Description Providinq and installing data drops at the Martin Luther King Jr. <br />Center — See memo <br />For Change Orders Only <br />Amount of F] increase $ <br />n Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />1-1 E] <br />El El <br />