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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 12, 2016 <br />Name Beth Leonard Inks <br />Department Community <br />Investment <br />BPW Date June 19, 2016 Phone Extension 9330 <br />Required Prior to Submittal to Board <br />Legal x❑ Attorney Name Ben Dougherty: Michael Schmidt <br />Controller El greater <br />review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />x❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />n Other: <br />Company or <br />Required Information <br />Weidner and Company PC. <br />New Vendor x U Yes LJ No xLJ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBEM/BE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Not -for -Profit Accounting <br />Project Number <br />N/A <br />Funding Source <br />DCI Admin <br />Account No. <br />211-1001-460-31.06 <br />Amount <br />$ 65/hour <br />Terms of Contract <br />7/1116 thru 12/31/16 <br />Purpose/Description <br />To handle NFP accounting work for I <br />LJ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of H Increase <br />I-1 Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />