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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 19th 2018 <br />Department Innovation and <br />Name Brian Donoghue Technology ry n <br />BPW Date December 20t" 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 E] <br />Check the A <br />"Agreement <br />❑ Professional Services <br />[l Bid Opening <br />❑ Quote Opening <br />❑ Chg Order No. <br />EJ Ease./Encroach. <br />R Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />iro riate Item T e — Re i <br />Z Contract <br />❑ Amendment <br />El Bid Award <br />El Quote Award <br />El C/O & PCA No. <br />EJ Traffic Control <br />'for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />M Resolution <br />M Claim <br />Addendum <br />❑ Title Sheet <br />Required Information <br />Collective Shift merging under Southern New Hampshire <br />University SNHU) <br />❑ Yes❑ If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />LRNG Platform _ <br />Department of Innovation and Technology Professional Services <br />279-0672-415-31-06 <br />Collective Shift merged with SNHU. As p,art of our June 2018 <br />contract with Collective Shift it re uires our approval for them to <br />move forward with the merger. Nothing in the contract has <br />changed. Sandra Kennedy has reviewed it and has signed off on <br />For Chainee Orders <br />Amount of D Increase <br />F Decrease $ <br />Previous Amount $ <br />Current Percent of Change: _........_ % <br />New Amount $ <br />Total Percent of Change: % <br />....... ._.......... ---- . -.. ...... <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />