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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9-1-2016 <br />Name Santiago Garces Department Innovation <br />BPW Date 9-13-16 Phone Extension 7652 <br />I Required Prior to Submittal to Board <br />Legal ® Attorney Name Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />unecK the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />® <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />❑ <br />Other: <br />Company or Vendor Name <br />New Vendor <br />Yes <br />MBEM/BE Contractor ❑ MBE [ <br />MBE/WBE Contractor Requested ❑ No <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Previous Amount <br />No [ <br />WBE <br />Information <br />It Yes, Approved by Purchasing <br />Yes Name of Company <br />COIT Fund Professional Services <br />404-0672-415-31-06 <br />$ 31,200 <br />8/1/2016 — 12/31/2016 <br />Professional Services contract for IT consultation <br />® 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 />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />® ❑ Brian <br />® ❑ Penn <br />® ❑ John <br />Dispersal After <br />