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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/20/2019 <br />........... <br />Department VPA: Facilities & <br />Name Patrick Sherman Grounds <br />BPW Date 06/25/2019 Phone Extension 5601 <br />NMMMIMMMMMMMM�ff <br />...FN4��rior to Submittal to Board <br />Legal Attorney Name Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Michael Schmidt <br />Check the <br />E] Agreement <br />❑ Professional Services <br />Bid Opening <br />E] Quote Opening <br />E] Change Order No. <br />El Ease/Encroach. <br />N Other: OPA Purchase <br />)ropriate Item Type - <br />Contract <br />El Resolution <br />El Bid Award <br />F Quote Award <br />El C/O & PCA No. <br />F-1 Traffic Control <br />for All Submissions <br />. ..... . ......... - <br />Proposal <br />El Req. to Advertise <br />Required Information <br />Company or Vendor Name Network Solutions Inc. <br />F-1 PCA <br />Addendum <br />El Title Sheet <br />New Vendor <br />F Yes M No E If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />F-1 MBE 0 <br />WBE <br />MBE/WBE Contractor Requested N No E] Yes Name of Company <br />Project Name <br />Howard Park IT infrastructure <br />Project Number <br />1090-2019 <br />Funding Source <br />Cum gap Fund 406 . ....... - ­­­­ <br />.... — - - ------ ...... . ....... <br />Account No. <br />406-1101-452.42-01 <br />Amount <br />$60,643.46 <br />Terms of Contract <br />Indiana Cisco Q15A—,Contract #1 2-921"" . ..... <br />Purpose/Description <br />­­­ — - — ------- - . . . .......... <br />IT Infrastructure and switched at Howard Park <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination Non -Debarment, E �erif ..Iran, etc. <br />Reauired For Chanae Orders OnIv <br />Amount of EJ increase $ <br />E] Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />El <br />n <br />0 <br />El <br />E] <br />n <br />