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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/1 /19 Department Fire <br />BPW Date 4/9/19......................._.a� .��.... —.m..m.._� Phone 9.2.5.5......_ <br />Name Todd Skwarcan„ A/C Services <br />qN iW/NNPJ:Nf9�i�1�MMilM'ITT'H�Gl6H✓iY✓�flIMDdWNr"/eld�iii'fY�V�IWIIIWiI�IiWIiIWWWWWWWWV�WV�IPW11f1N4Ad/,'NNli/L9�9VYAWRPoNNAPoggY�MNINGLL9 a3E9'E4�/V4WIi <br />o Legal Z Attorney Name Elliot Anderson, Clara McDaniels <br />o CU -0 <br />o m Controller El <br />U) Purchasing <br />Check the A <br />A reement <br />Claim <br />Bid Opening <br />Quote Opening <br />Chq Order No. _ <br />Ease./Encroach. <br />Other: <br />Controller review is required for all Contracts $5,000.00 or more <br />and greater than one year in length per the City Purchasing <br />Policy <br />Michael Schmidt <br />g Submissions <br />on <br />�� Contrlacm Type Required Propoisal........�._.�.�..� <br />Addendum <br />Bid Award <br />Quote Award <br />C/O & PCA No <br />Traffic Control <br />Ise uired Information <br />Company or Vendor Name I TriZetto Provider Solutions <br />Rea. to Advertise <br />PCA <br />Resolution <br />Title Sheet <br />New Vendor <br />Yes El <br />No El If Yes, Approved by Purchasing <br />m. m................................mm...... <br />MBE/WBE Contractor <br />_0 __ <br />MBE WBE <br />Protect Name mm .... <br />�.. ... ........ _ ....... ..m,_ .... <br />Billing Software <br />EMS _ m <br />Pro'eecct Number <br />........ ._ ....... w� <br />EMS Operations - Professional Services <br />Funding Source <br />.................. _�_ <br />Account No, <br />288-0.9.0.2-422..3.1..._04.......m <br />Amount <br />$ 360/mo. with additionaloptions ( service o bons at additional per item <br />-- <br />cost <br />Terms of Contract <br />.............. ,__..... .- �.........______www...... m, <br />12 months + 12 month renewal <br />Purpose/Description <br />Improved software for EMS billing services <br />. <br />or Change Orders ". <br />.�..... � .....:..kii::i�rease <br />Amount of <br />[ <br />_ ........... <br />$ <br />❑Decrease <br />$ <br />Previous Amount <br />_... . _................. <br />$ <br />Current Percent of Change: <br />New Amount <br />������r� m..m...........���. <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Dispersal After Approval <br />Copy Original <br />