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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />10/16/18 <br />Matt Coats <br />Department Innovation & Technolo <br />BPW Date 10/23/18 Phone Extension 5817 <br />Rewired Prior to Submittal to Board <br />Legal Attorney Name Clara McDaniels <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 <br />the Appropriate <br />Item Type - Required <br />for Aff Submissions <br />F-1 Agreement <br />Contract <br />R Proposal El Addendum <br />❑ Professional Services <br />❑ Amendment <br />F] Bid Opening <br />Bid Award <br />❑ Req. to Advertise Title Sheet <br />❑ Quote Opening <br />El Quote Award <br />Chg Order No. <br />F-1 C/O & PCA No, <br />E] PCA <br />F-1 Ease./Encroach. <br />❑ Traffic Control <br />R Resolution <br />R Other: <br />F-1 Claim <br />Reauired Information <br />Company or Vendor Name Systems & Software <br />M Yes F-1 If Yes, Approved by Purchasing <br />New Vendor <br />n No <br />0 MBE Yes <br />MBE/1 BE Contractor <br />Completed E-Verify Form Attached <br />E] WBE F] No <br />Project Name <br />Utility B,illir? Software and Nm lamentation Services <br />Project Number <br />Funding Source <br />Support Services for Software Implementation <br />Account No. <br />620-0640657-31-06, 641-0630-793-39-10, <br />Amount <br />TBID <br />Terms of Contract <br />TBD <br />Purpose/Description <br />For Chane Orders Only <br />Amount of El <br />increase $ <br />El <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />❑ N <br />Al Greek; Kim Thompson <br />F-1 <br />Matt Coats <br />ni n <br />