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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/16/2019 <br />Name Brian Donoghue Department Innovation & Technology <br />BPW Date 12/19/2019 Phone Extension 7652 <br />._ ..... ... <br />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 <br />Check the Appropriate Item Type — Required for All Submissions <br />X Professional Services Agreement H Contract <br />❑ <br />Open Market Contract <br />Amendment/Addendum <br />❑ <br />Bid Opening <br />Bid Award <br />]] <br />Quote Opening <br />Quote Award <br />E <br />]' Proposal Opening <br />❑ <br />C/O & PCA No. <br />❑] <br />Chg. Order, No. <br />❑ <br />Traffic Control <br />F 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 />LJ Proposal <br />0 Special Purchase, QPA <br />[] Req. to Advertise ❑ Title Sheet <br />F Reject Bids/Quotes <br />[� PCA <br />❑ Resolution <br />Ease./Encroach <br />Enfocus <br />❑ u. ........ <br />Yes❑ If Yes, Approved mbyPurchasing ...... <br />No <br />E] MBE <br />WBE Completed E-Verify Form Attached El Ye <br />n/a <br />IT Operatin........_.......................... <br />279-0672-415.31-06 <br />$112,000 <br />1/6/2020 — 12/31/2020 <br />Fellowship program for project support for projects across Innovation & <br />Technology portfolio <br />...._W_ — . <br />For Change Orders Only �_.......m <br />Amount of ❑ Increase $ <br />n Decrease $ <br />Previous Amount $ <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 />® <br />❑ Denise Riedl <br />® <br />❑ Brian Donoghue <br />® <br />❑ Daniel Parker <br />