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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/7/19 _ <br />Name Shawn Dela y <br />_... hant Department Innovation &Tech <br />Purchasing <br />ww._. <br />Check the A <br />Agreement <br />❑ Professional Services <br />El Bid Opening <br />Quote Opening <br />Chg Order No. <br />❑ Ease./Encroach. <br />l 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 />iropriate Item Type — Required for All Submissions <br />M Contract F Proposal <br />❑ Amendment <br />❑ Bid Award Req. to Advertise <br />❑ Quote Award <br />C/O & PCA No. ❑ PCA <br />[� Traffic Control Resolution <br />_ E, Claim <br />Reauired Information <br />Addendum <br />❑ Title Sheet <br />Kronos <br />.. .................. <br />El Yes El If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached F] Yes <br />F WBE n No <br />Renewal of annual hardware maintenance <br />IT Operating <br />............... ............... <br />279-0672-415.36-04 <br />$13,058.98 — <br />1 year ......................... _ ... _ --------- <br />Depot exchan a maintenance for 29 Kronos timeclocks <br />For Chanee Orders On[ <br />Amount of ❑ Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: _.......... <br />.._....... <br />New Amount $ <br />_.................. _ ................. _ ................... <br />Total Percent of Change: %mITmmmmmmm wwwwwwwwwwwwwwwwwww <br />Time Extension: <br />....................... ..... _.__ ..... <br />Dispersal After Approval <br />Copy Original <br />® ❑ Shawn Delahanty <br />