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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1-15-2019 <br />Name Dan O'Connor <br />Purchasing <br />Check the <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. _ <br />Ease/Encroach. <br />Other: <br />are riate Item Ty e — <br />Contract <br />Resolution <br />Bid Award <br />❑ Quote Award <br />C/O & PCA No. <br />F-1 Traffic Control <br />Company or Vendor Name Mir StaffingPra <br />Department Innovation <br />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />red Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />New Vendor ElYes 0 No ❑If Yes, Approved by Purchasing <br />MBE/WBE Contractor F] MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />MyStaffingPro Self -Service Export Module (One-time <br />Project Name implementation fee and 12-month license monthlymfe� <br />Project Number <br />Funding Source IT Professional Services and Operating <br />Account No. 279-0672-415.31.-06 ($1500) and 279-0672 415.36-04 ($900 <br />_.__..._ <br />Amount Total amount = $2,400 <br />Terms of Contract A one-time fee of $1,500 and license fees of $75 per month for 12 <br />months <br />Purpose/Description A reement for the im lementation of a self-service exportITmodule in <br />the City of South Bend's existingapplicant tracking system, <br />M Staffin Pro so that new hire data can be exported and then <br />im �o�rted into Kronos. Includes a 12-month license fee. <br />Required Contractor's Certification Form Attached (Non -Collusion, <br />Non -Discrimination, Non -Debarment, E-Verifv. Iran. etc.) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ ............. <br />Total Percent of Change: <br />Copy Original <br />® ❑ Dan O'Connor <br />. ...._.... _......... . <br />® F Shawn Delahai <br />Dispersal After Approval <br />