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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />2-19-19 <br />Brian Donoghue <br />Purchasing M <br />Check the <br />H Agreement <br />M Professional Services <br />F-1 Bid Opening <br />E] Quote Opening <br />E] Change Order No. <br />F-1 Ease/Encroach. <br />0 Other:.. <br />iropriate Item Typ <br />F-1 Contract <br />❑ Resolution <br />Bid Award <br />F-1 Quote Award <br />C/O & PCA No, <br />Traffic Control <br />Company or Vendor Name Jacob Burnett <br />Department Innovation <br />for All Submissions <br />I Proposal 07,�d d e -nd u m <br />0 Req. to Advertise E:1 Title Sheet <br />red Information <br />El PCA <br />New Vendor E] Yes E No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 MBE [:] WBE <br />MBE/WBE Contractor Requested E] Noj Yes Name of Company <br />Project Name <br />Project Number <br />......... . ..... <br />Funding Source IT Profe. <br />ssional Services <br />Account No. 279-0672-415-31-06 <br />. . ............. .. ............ <br />Amount $20,000 <br />Terms of Contract 2/19/2019 - 6/30/2019 <br />. . . . . . . . ...................... <br />Purpose/Description Contract agreement for professional services for IT pro*ect portfolio <br />management <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Veffy, Iran, etc._ <br />Required For Change Orders 0rtNe <br />Amount of El increase $ <br />F-1 Decrease $ ..................... .... - ..................... <br />Previous Amount $ <br />.ITITmm .......... . . ............. <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />F-1 Brian Donoghue <br />................................................. <br />Dan O'Connor <br />. . . . .................. . . . . . ............ <br />Shawn Delahanty <br />