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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8-16-2016 <br />Name Santiago Garces Department Innovation <br />BPW Date 8-23-16 Phone Extension 7652 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I-1 Other: <br />Company or Vendor Name <br />EnFocus <br />New Vendor <br />❑ Yes <br />MBE/WBE Contractor <br />❑ MBE [ <br />MBE/WBE Contractor Requested ❑ No <br />Project Name <br />Project Number <br />Funding Source <br />COIT Fu <br />Account No. <br />404-067, <br />Amount <br />$ 40,000 <br />Terms of Contract <br />8/8/2016 <br />Purpose/Description <br />Fellowsh <br />Amount of <br />uired Information <br />No LJ If Yes, Approved by Purchasing <br />WBE <br />] Yes Name of Company <br />Services <br />E Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />® ❑ Sant <br />® ❑ Penr <br />® ❑ John <br />Dispersal After Approval <br />to Garces <br />Price <br />