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HOARD OF PU13LIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7-2-18 <br />Name Santiago Garces Department —Innovation <br />BP' Date 7-10-18 Phone Extension 7652 <br />Legal Attorney Name Kennedy <br />Controller Controller review is required for all Contracts $5,,000.00 or more and <br />greater than one year in length Iper the City Purchasing Policy <br />Purchasing <br />H Agreement H Contract L] Proposal Ll Addendum <br />N Professional Services 0 Resolution <br />F-1 Bid Opening El Bid Award El Req. to Advertise F-1 Title Sheet <br />El Quote Opening El Quote Award <br />Change Order No. E] C/O& PCA No. P CA <br />❑ Ease/Encroach. R Traffic Control <br />Other: <br />Company or Vendor Name Jacob Burnett <br />New Vendor [] Yes Z No El If Yes, Approved by Purchasing <br />MBEAIVBE Contractor F-1 MBE FlI WBE <br />MBEANBE Contractor Requested[] No Yes Name ofCompany <br />_ <br />Project Name <br />Project Number <br />Funding Source IT Fund Professional Services <br />Account No. 404-0672-415-31-06 <br />Amount $35,000 <br />Terms of Contract 7/1/2018 — 12/31/20,118 <br />Purpose/Description Professional Services for Redevelopment Supervisory Services <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of F-1 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 />z n Santiago Garces <br />z E] Shawn Delahanty <br />z n Dan O'Connor <br />