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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/29/19 <br />Department <br />Name Daniel O'Connor Innovation & Tech <br />BPW Date 11/12/19 Phone Extension 6201 <br />W ilOr )9N N[Y/0/He/HHAyiANFPoWMii/13f5A1e'+. �Jbu &M IW,TJGW.W.R�MI�MMI9�llIW'IIVVWWllWL'W!W'W.�IWIW.NIWWIW.'WIWIIV iVNNIW vmm. .mvz�mrrq PlA9llJ9lA1�/9J/W °lAWi.WWWW.W�V�V�W�W�W�WNW.W;.W!'W.YW.'W:WWWWWOi✓." <br />��.�m„w,m....,..,,�..m.e�.........mm............ �......................�.�..... ,,,,,,,,,m.m.m .... ..�,.... ..,�... wmm .....m..... mm..... �...�.�.. ...���. <br />Req,�ncd Prior to Submittal to Board <br />BPW Attorney Attorney Name McDaniels <br />Dept. Attorney Attorney Name Kennedv <br />Purchasing ® Schmidt <br />Check the Appropriate Item Type -- <br />Professional Services Agreement E] Contract <br />E] <br />Open Market Contract ❑ Amendment/Addendum <br />❑ <br />Bid Opening [-I Bid Award <br />Quote Opening EJ Quote Award <br />[� <br />Proposal Opening C/O & PCA No. <br />Chg. Order, No. E] 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 />uired Information <br />All Submissions <br />Proposal <br />L_] Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />Woolpert <br />❑ ❑ If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached Yes <br />❑ WBE No <br />Cityworks implementation of Permits, Licensing and Land(PLL) module <br />or Business Licensing within DCI <br />IT Profesional Services <br />279-0672-415.31-06 <br />Professional Services Statement of Work Work <br />To implement the PLL CityWorks module for Business Licensing in DCI <br />For Chan ge Orders Only« ...._ _ ... __... .... __:._ ..�.......� ... ......._ ..._ .. <br />Increase $ <br />Amount of <br />�] Decrease ($ ) <br />Previous Amount <br />$ <br />m.....Increase...........�...................... <br />,,._ <br />Current Percent of Change: <br />Decrease <br />% <br />New Amount <br />$ � <br />mm( <br />Increase <br />�...............................%... <br />Total Percent of Change: <br />Decreased <br />% <br />Time Extension Amount: <br />New Completion Date: <br />