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M <br />BOARD OF PU13LIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/19/17 <br />Jeri Hockenhull <br />Department A/F <br />BPW Date 12/21/17 Phone Extension 9822 <br />Legal Attorney Name Stephanie Steele <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />UI Agreement X Contract H Proposal Ll Addendum <br />Z Professional Services F-1 Amendment <br />F-1 Bid Opening El Bid Award F1 Req. to Advertise El Title Sheet <br />n Quote Opening El Quote Award <br />El Chg Order No. n C/O & PCA No. ❑ PCA <br />Ease./Encroach. F] Traffic Control Resolution <br />Other: ❑ Claim <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <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 />BenXpress (Accordware LLC) <br />F1 Yes El If Yes, Approved by Purchasing <br />No <br />MBE CBE No Completed E-Verify Form Attached ❑Yes <br />Benefit website for employees <br />Self -Funded Employee Benefits <br />711-0401-671.31-016 <br />$50,400 annual — 1 year <br />1 year (January — December 2018) <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy <br />Original <br />F] Kyra Clark <br />F-1 Tierra Davis <br />El <br />1-1 <br />