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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/9/18 <br />Name Shawn PelahantyDepartment Innovation & Tech <br />BPVV Date ­ 1/23/18 one Extension_ 6,205 <br />Required Prior to Submittal to Board <br />Legal Attorney Name McDaniels <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 />❑ Agreement <br />Professional Services <br />Bid Opening <br />F-1 Quote Opening <br />F-1 Chg Order No. <br />❑ Ease./Encroach. <br />Other- QPA Renewal <br />Company or Vendor Name <br />New Vendor <br />MBEMBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />" Contract <br />El Amendment <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PGA No. <br />F-1 Traffic Control <br />Proposal <br />0 Req. to Advertise <br />F1 PCA <br />F1 Resolution <br />9 Claim <br />Addendum <br />F1 Title Sheet <br />CDW Government <br />F1 Yes El If Yes, Approved by Purchasing <br />No <br />MBE Completed E-VEl doserify Form Attached R <br />Renewal of Adobe licensina <br />IT Operating <br />279-0672-415-36-04 <br />year renewal <br />For Change Orders Only <br />Amount of El increase $ <br />El 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-1 Shawn Delaha <br />❑ <br />F] <br />El <br />