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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/09/2016 <br />Department <br />Name Daniel O'Connor <br />Innovation & <br />Technology <br />BPW Date 09/27/2016 Phone Extension 6201 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />® Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Company or Vendor Name <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Microsoft Dynamics CRM Implementation <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />IT <br />$ 47,950 <br />Change Request amount not to exceed $47,950 <br />Professional Services Agreement — Adoxio — MS Dynamics CRM <br />Implementation dated December 22 2015. This requested change <br />is due to changes in scope rework and adjusting out the go live <br />date to 09/27/2016. <br />❑ Required Contractor's Certification Form Attached (Non <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ZI Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change: 26 <br />New Amount $ 217,7 <br />Total Percent of Change: <br />Copy Original <br />❑ ❑ <br />7,950 <br />After Approval <br />