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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />4/24/2019 <br />Danielle Fulmer <br />Department I&T <br />BPW Date 5/14/2019 Phone Extension 6018 <br />Re aired Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Sandi Kennedy <br />...... <br />Purchasing ® Michael Schmidt <br />Check the Appropriate Item Type <br />Professional Services Agreement 0 Contract <br />Open Market Contract <br />❑ <br />Amendment/Addendum <br />Bid Opening <br />El <br />Bid Award <br />Quote Opening <br />El <br />Quote Award <br />Proposal Opening <br />❑ <br />C/O & PCA No. <br />Chg. Order, No. <br />❑ <br />Traffic Control <br />Other: <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 />Altrics <br />Yes [— <br />_gym <br />Information <br />All Submissions <br />Proposal <br />U Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheel <br />❑ Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />Ease./Encroach <br />If Yes, Approved by Purchasing <br />[:1 MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />Renewal for Enterprise Survey Solution <br />N/A <br />O eatink.__.. ......�� <br />279-0672-415.36-04 <br />._.. _. <br />$5,393_..w_ ....... <br />Net30 .�..... _..._....... .___ <br />Renewal of survey platform used by multiple departments across the city t c <br />collect data from both residents and employees and report on results. <br />For C'hn e Orders 3nl! <br />Amount of � Increase $ <br />Decrease _($ <br />Previous Amount $ <br />.......... m._­--._ ..........._......... _. ............... <br />Increase % <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease ( %)......... <br />Time Extension Amount: <br />New Conplti Date; <br />