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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/4/19......._._... <br />Name Sue Gerlach <br />Purchasing <br />Check the A <br />Agreement <br />El Professional Services <br />❑ Bid Opening <br />El Quote Opening <br />Chg Order No. <br />❑ Ease./Encroach. <br />® Other: HP Lease <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 />Amount of <br />Department Innovation Tech <br />►ropriate Item Type_ Regi <br />�❑ Contract <br />❑ Amendment <br />DI Bid Award <br />Quote Award <br />El C/O & PCA No. <br />F] Traffic Control <br />'for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />❑ Resolution <br />❑ Claim <br />Addendum <br />❑ Title Sheet <br />Required Information <br />Hewlett Packard <br />Yes If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached ❑ Yes <br />WBE ❑ No <br />HP Computer Lease #20 <br />_.. ........... _ ....... <br />N/A <br />Capital Lease Proceeds <br />........_ _w........... <br />Prin. 279-0672-415-38-01 I nt. 279-0672-415-38-02 <br />.............. ......... <br />$24,205.00 <br />$513.22/Mo. For 48 Months <br />Equipment for new or chang <br />ed positions <br />Increase <br />Decrease <br />Previous Amount mm $ ._... <br />Current Percent of Change„ �... <br />New Amount $ <br />._. .......... . <br />Total Percent of Change: <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />E] <br />❑ <br />❑l <br />