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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/16/2019 <br />Name Brian Dono bt�Me Department Innovation & Tee��lmolo <br />BPW Date 12/19/2019 Phone Extension 7652 <br />Reouired 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 />.... ..._ __ ._........_.. <br />Check the Appropnate Item Type—ITRequired for All Submissions <br />® Professional Services Agreement F-1 Contract ❑ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />Bid Opening ❑ Bid Award EJ Req. to Advertise ❑ Title Sheet <br />Quote Opening Quote Award E] Reject Bids/Quotes <br />Proposal Opening C/O & PCA No. F-I PCA <br />[❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />❑j Other: ❑ Ease./Encroach <br />Required Information <br />Company or Vendor Name Invanti LLC . ........ www ----...._......— <br />® Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />❑Yes <br />MB <br />MBE/WBE Contractor <br />❑ E Completed E-Verify Form Attached No <br />Project Name <br />Project Number <br />n/a .......__ ..... <br />Funding Source <br />OTHER COMMUNICATION/TRA NSPORTATION <br />Account No. <br />279-0672-415.31-06 <br />Amount <br />$34,500 <br />Terms of Contract <br />12/19/2019 — 12/19/2020 a— <br />Purpose/Description <br />Provide technical and project management support for innovation romm <br />p gram <br />activities funded by Bloomberg Philanthropies <br />For Change Orders Only <br />..❑ <br />... <br />Amount of <br />E] <br />_ ..._.... <br />Increase $ <br />Decrease $mmm <br />Previous Amount <br />$ <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change: _.... -_ %__.._............................_.._._.....__._. 4 <br />Time Extension: <br />................ <br />Dispersal After Approval <br />Copy Original <br />® F-1 <br />Denise Riedl <br />® (l <br />Brian Donoghue _._............�.�_�...........� �� .�..........�_...._._. .... <br />® <br />- <br />Daniel Parker <br />