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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />9/17/19 <br />Denise Riedl <br />Department Innovation & Tech <br />BPW Date 9/24/19 Phone Extension 6004 <br />��WHWM� <br />E ....... . ......... . ......... Required Prior to Submittal to Board <br />Legal Attorney Name Kennedy <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing Z <br />Check the P <br />Z Agreement <br />El Professional Services <br />El Bid Opening <br />E:1 Quote Opening <br />[:]'Chg Order No. <br />F Ease./Encroach. <br />F] Other: <br />yppriate Item Type - <br />F1 Contract <br />F-1 Amendment <br />El Bid Award <br />F-1 Quote Award <br />El C/O & PCA No. <br />F1 Traffic Control <br />for All Submissions <br />Proposal <br />El Req. to Advertise <br />Ej PCA <br />E] Resolution <br />F-1 Claim <br />Addendum <br />El Title Sheet <br />BpcL <br />. . . . . ... ...... .. . ........................ — Required Information .......... <br />Company or Vendor Name Romona <br />New Vendor �Yes­- --0 If Yes, Approved by Purchasing <br />E] No <br />MBENVBE Contractor WBE <br />ElCompleted E-Verify Form Attached No <br />Project Name ,Project Management Support for GVI <br />Project Number <br />. . . . . . ................ . . <br />Funding Source IT Professional Services <br />Account No. 279-0672-415.31-06 <br />Amount 11 '0 00 <br />Terms of Contract October 1, 2019 - December 31. 2019 <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />z <br />E] Denise Riedl <br />z <br />0 Brian Donoghue <br />z <br />E] Shawn Delahani <br />