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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4-16-19 <br />Name mBrianmmDonoghue Department Innovation <br />BPW Date 4-23-19 Phone Extension 7652 <br />a^ amrunaarwi� uwnuuuuuuuuuuuuuuuuuuuuuuuuuuum!w mnwidvmr�r.Huinr��ness uamnuwwmwmuia����!m vmw NINDrNow�, a✓ u, w nuw�r,,wm�ervwouwwmuwwwwwwwwwwwwwmwwwwwwmwww �www✓vnra <br />......... ............. ......—..�.._.. .. ........ <br />e�uired Prior to Submittal to Board <br />Legal ® Attorney Name Kennedy <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the <br />LI Agreement <br />Professional Services <br />0 Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />F] Ease/Encroach. <br />El Other: <br />Iropriate Item Tyke <br />Contract <br />Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. _ <br />❑ Traffic Control <br />for All Submissions <br />� Proposal ❑ Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />❑ PCA <br />Company or Vendor Name Aaron Steiner <br />New Vendor ® Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source L...............es <br />Fund Professional <br />� � �..................�w _ _.....�m, � � �........................................................----------- A,.......y�..n..................... <br />T onal Services <br />Account No. 2................�...........��...............................w�w�w�w�w__�..�.,,�_...�........................................................................m. �__a. <br />79-0672-415-31-06 <br />Amount$9.8..0.0.................................. --- <br />Terms of Contract 5/5/2019 .................._ mm,,,,.m... ��....� <br />— 5/5/2020 <br />Purpose/Description Professional Services for Bloomber Mayors Challenge <br />e <br />' e <br />management <br />Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify,Iran, etc. <br />Required For Chap _Orders Only <br />Amount of ❑ Increase $� <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® Denise Reidl <br />z El Daniel Parker <br />® Brian Donoghue............................................................................................... <br />