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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2-5-2019 . ........ ... Name Dan O'Connor <br />Purchasing 0 <br />Check the, <br />LJ Agreement <br />M Professional Services <br />E] Bid Opening <br />El Quote Opening <br />[] Change Order No. <br />F-1 Ease/Encroach. <br />1� Other: <br />iropriate Item Type - <br />F1 contract <br />F-1 Resolution <br />Department Innovation <br />for All Submissions <br />F—Proposal <br />El Bid Award ❑ Req. to Advertise <br />El Quote Award <br />R C/O & PCA No. ❑ PCA <br />F-1 Traffic Control <br />Required Information <br />Company or Vendor Name Kronos Inc. <br />Addendum <br />El Title Sheet <br />New Vendor ElYes [Z No nIf Yes, Approved by Purchasing <br />MBENVBE Contractor [] MBE F-1 WBE <br />MBENVBE Contractor Requested [:] No F-1 Yes Name of Company <br />Project Name Chang ..order for Kronos HR Payroll Project Timeline Extension <br />Project Number <br />Funding Source IT Professional Services <br />. ......... <br />Account No. 279-0672-415.31-06 <br />.................. <br />Amount $26,400 <br />Terms of Contract 176 hours at a rate of $150 per hour ................ . . . . .......... <br />Purpose/Description Change order to accommodate a timeline extension for the <br />implementation of the Kronos HR Payroll Ustem. <br />FIRequired Contractor's Certification Form Attached (Non -Collusion, <br />-------------- - - Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of [:] increase $ <br />F] Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />Dan O'Connor <br />-Shawn Delaha I <br />El <br />El <br />Dispersal After Approval <br />