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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12-18-2018 <br />Name Brent Hussunq Department Utilities <br />_.._.. <br />BPW Date 12-20-2018 Phone Extension 5512 <br />uwuu�mmm ow.�o�.mmmmmmmmum�mmmmmwn io MMM1uuuuuum�wnm�rmure rrrm nm�mmummmmmuiuiuimuimv�im immmmuuuuuuuuuuumui wwwuwmiimmmm F <br />..�.�....�.�.�.�...... ...._._........... ......... ...............�......_�. <br />Required Prior to Submittal to Board <br />Legal Attorney Name <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 <br />H Agreement <br />❑ Professional Services <br />El Bid Opening <br />Quote Opening <br />Chg Order No. <br />Ease./Encroach. <br />I� d 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 />►romate Item Tyke - <br />Contract <br />❑ Amendment <br />El Bid Award <br />® Quote Award <br />❑ C/O &PCANo. <br />_ <br />❑ Traffic Control <br />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />PCA <br />El Resolution <br />[7 Claim <br />Required Information <br />Dell Marketing LP ........... <br />Yes _... ❑ If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached <br />❑ WBE <br />Ca p�ta............................................................ <br />642.0630.415.43.08 <br />$15,188.52 <br />Addendum <br />❑ Title Sheet <br />El Yes <br />No <br />Replacement of three 3 existing SCADA Virtualization Servers <br />for running the I&C SCADA systems of Water Works and <br />Wastewater Plants doe to end of life of existing hardware <br />For Chartoe Orders Only <br />Amount of [:] Increase <br />EJ Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />El <br />0 <br />El <br />El <br />E] <br />