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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Shawn Delahantv <br />Department Innovation & Tech <br />BPS/ Date 8/28/1 8 Phone Extension 6202 <br />Re !red Prior to Submittal to Board <br />Legal Attorney Name Kennedy <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller Z and greater than one year in length per the City Purchasing <br />Policy <br />LJ <br />Agreement <br />Ll Contract <br />H Proposal L] Addendum <br />El <br />Professional Services <br />El <br />Amendment <br />F-1 Bid Opening <br />❑ <br />Bid Award <br />n Req. to Advertise El Title Sheet <br />n Quote Opening <br />❑ Quote Award <br />F-1 <br />Chg Order No. <br />❑ C/O & PCA No. <br />F1 PCA <br />El <br />Ease./Encroach. <br />F-1 Traffic Control <br />El Resolution <br />F-1 <br />Other: <br />F-1 <br />Claim <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />Project Name <br />Project Number <br />Canon <br />F-1 Yes <br />If Yes, Approved by Purchasing <br />U No <br />El MBE n BE Completed E-Verify Form Attached Nos <br />W <br />Uniflow Agreement — change from Corporate to Enterprise <br />Funding Source <br />IT Operating <br />Account No. <br />279-0672-415.36-04 <br />Amount <br />Part of Canon Master Lease approved by BOPW on 7/24/18 — <br />a <br />roved amount of agreement not affected <br />Terms of Contract <br />Purpose/Description <br />Change <br />the licensing from Corporate to Enterprise <br />For Change Orders Only <br />Amount of El increase <br />$ <br />El Decrease <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />F-1 1-1 <br />El F-1 <br />F-1 El <br />