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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/15/17 <br />Name Sue Gerlach Department IT <br />BPW Date 5/23/17 Phone Extension 5209 <br />Required Priortc Subriital tosBoad.,. <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 0 <br />LJ Agreement Contract L Proposal L 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: Lease Sche.duie. <br />Company or Vendor Name HP <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 2017 Computer Deployment/Refresh <br />Project Number N/A <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Multiple See attached <br />Multiple See attached <br />$109,841.75 <br />$2332.21/Month for 48 months <br />Purpose/Description 2017 Computer Deployment/Refresh <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verity, Iran, etc,) <br />01 <br />Amount of <br />❑ 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 />0 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />