Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11-16-2016 <br />Name Santiago Garces Department <br />Innovation <br />BPW Date 11-22-16 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 Tvne — Reauired fnr All .4iihmiccinn.c <br />LJ <br />Agreement <br />U 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 />I-1 <br />Other: <br />Required Information <br />Company or Vendor Name Anna Kennedy <br />New Vendor ® Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBEM/BE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source COIT Fund Professional Services <br />Account No. 404-0672-415-31-06 <br />Amount $ 6,000 <br />Terms of Contract 11/22/2016 — 12/31/2016 <br />Purpose/Description Design Professional Services for araphic desian and process <br />Amount of <br />improvement related to digital and print assets <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran, etc <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 />For Change Orders On <br />"/o <br />Dispersal After Approval <br />Garces <br />