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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />11/15/18 <br />Michael Sniadecki <br />Purchasing <br />Check the <br />JZJ Agreement <br />❑ Professional Services <br />Bid Opening <br />❑ Quote Opening <br />Chg Order No. <br />EEase./Encroach. <br />F� Other: <br />01 Up <br />El Contract <br />❑ Amendment <br />El Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />uired_ I <br />Department Innovation & Tech <br />for All Si <br />Proposal <br />❑ Req. to Advertise <br />n <br />❑ PCA <br />Resolution <br />El Claim <br />Addendum <br />❑ Title Sheet <br />Company or Vendor Name <br />Count .. ___ <br />New Vendor <br />_............... <br />El Yes El If Yes, Approved by Purchasing <br />No <br />MBE/WBE Contractor <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Project Name <br />Increased, consolidated Internet bandwidth <br />....._._ <br />Project Number <br />...................�............_ __ _._.... <br />Funding Source <br />..... _ .......... <br />IT Operating and Professional Services <br />Account No. <br />279-0672-415.36-01 and 31-06 <br />Amount <br />$950 per month for 1 year, $1000 ProfSvs ($12,400 total <br />Terms of Contract <br />Purpose/Description <br />_ <br />Consolidation of internet service between D TSB Wi-Fi COSB <br />Guestportion.),,,several VPA location & Centu Center <br />For Chief Orders Only <br />❑ Increase <br />Amount of <br />$._ ........�-..---- <br />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 />�.M .............. <br />Dispersal After Approval <br />Copy Original <br />® ❑ Michael Sniadecki <br />0 ..._........ ........ <br />........ .------- <br />