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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/1/2016 <br />Department Information <br />Name Jim Schrader <br />Technology <br />BPW Date 9/13/2016 <br />Phone Extension 6005 <br />Required Prior to Submittal to Board <br />Legal X <br />Attorney Name Michael Schmidt <br />Controller X <br />John Murphy <br />Purchasing X <br />George King <br />Check the Appropriate Item Type — Required for All Submissions <br />X Agreement <br />X Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />❑ Other: <br />Required Information <br />Company or Vendor Name <br />Network Solutions Inc. <br />New Vendor <br />❑ Yes X No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Logic Monitoring <br />Project Number <br />Funding Source <br />Equipment <br />Account No. <br />_Computer <br />40406724152325 <br />Amount <br />$ 13.464 <br />Terms of Contract <br />Purpose/Description <br />a 3 year contract <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of U Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />