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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE' VIEW REQUEST FORM <br />Date 1/8/20 - 1 - 8 Department Fire <br />BPVV Date 1/23/2018 Phone 9255 <br />Name Andrew Myer, Assistant Chiief, EMS <br />0 Legal Z Attorney Name Elliott Anderson <br />a) 0 2 Controller review is required for all'Contracts $5,000.00 or more -2 <br />7t-- m Controller and greater than one year in length per the City Purchasing <br />.2 E 0 <br />W L- -0 co <br />r0-y a_ :3 Policy <br />Purchasing F] <br />Check the Annronriatp Item TvnP — Perujimd fnr All .Rijhmi.cz.-qinn.,z <br />01=- <br />El Contract <br />El Proposal M� Addendiu—r�—1 <br />Bid Opening <br />F-1 Bid Aw-a-r-d" <br />Req. to Advertise <br />Title Sheet <br />El <br />Quote Opemng <br />Quote Award <br />Immirmr-RAi4 <br />der No. <br />C/O & PCA No. <br />El <br />PCA <br />16JE61*611 <br />Traffic Control <br />Resolution— <br />Reauired Information <br />._or Vendor Name <br />Compapy <br />Mi'chiana Health Information Network <br />New Vendor — <br />[9. <br />Yes D, No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />[] <br />MBE Lj WBE <br />Project Name <br />PDo'eqt_Number <br />Funding Source <br />Other Professional Service <br />Account No. <br />288.0902.422.31-06 <br />Amount <br />$2400 <br />Terms of Contract <br />Annual <br />Purpose/Description <br />Access and use of the MIN clinical data repositorV for <br />ambulance billing.. <br />For Chnnnp Orders 0n1v <br />Amount of <br />IElIncrease E] <br />Decrease <br />Previous Amount <br />$ <br />Current Percent of Change: <br />New Amount <br />% <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Dispersal After Approval <br />Copy Original <br />F-1 El <br />R 1-1 <br />