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130ARD OF PUI3LIC WQ R1KS <br />AGENDA ITEM REVIEW REQUEST" FORM <br />Date August 81st 2018 <br />Department Innovation and <br />Name Brian Donoghue Technology <br />BPW Date September 11tn 2018 Phone Extension <br />Required Prior to Submittal to Board <br />Legal Attorney Name Sandra Kennedy <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type -- Re uired for All ,Submissions <br />❑ <br />Agreement <br />❑ Contrast ❑ Proposal <br />❑ Addendum <br />EJ <br />Professional Services <br />® Amendment <br />❑ <br />Bid Opening <br />❑ Bid Award ❑ Rego to Advertise <br />Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Chg Order No. <br />Ease./Encroach. <br />❑ C/O &IPCA No. ❑IPCA ,.., <br />❑ Traffic Control Z Resolution <br />0 <br />Other: <br />❑� I Claim <br />Required Information <br />Company or Vendor Name <br />St. Joseph County Public Library <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />Z No <br />MBE/BE Contractor <br />❑ MBE Completed E-Verify Form Attached <br />0 WBE <br />ElYes <br />❑ No <br />Project Name <br />Digital Access Sites <br />Project Number <br />Funding Source <br />Department of Innovation and Technology Professional <br />Services <br />Account No. <br />279-0672- 15-81-06 <br />Amount <br />$25,000 <br />Terms of Contract <br />Purpose/Description <br />See memo <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />n Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />%Q <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />0 ❑ <br />❑I El <br />0 <br />