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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />2/6/18 <br />Sue Gerlach <br />Department IT <br />BPW Date 2/13/18 Phone Extension 6209 <br />Required Prior to Submittal to Board <br />Legal Attorney Name Previously reviewsby M. 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 />Check the Appropriate Item Type — Required for All Submissions <br />F-1 Agreement F Contract E] Proposal ❑ Addendum <br />El Professional Services F-1 Resolution <br />❑ Bid Opening ❑ Bid Award El Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening Quote Award <br />❑ Change Order No. F-1 C/O & PCA No. E] PCA <br />F] Ease/Encroach. Traffic Control <br />Z Other: Final cost change Required Information ------- <br />Company or Vendor Name Hewlett-Packard <br />New Vendor El Yes Z No [:1 If Yes, Approved by Purchasing <br />MBE/' VBE Contractor [:] MBEF1 WBE <br />MBEANBE Contractor Requested F] NoF_1 Yes Name of Company <br />Project Name HP Schedule 15 <br />Project Number N/A <br />Funding Source IT Lease <br />Account No, 279-0672-415-37-11 and 279-0672-415-37-12 <br />Amount $763.00 <br />Terms of Contract 48 Months <br />Purpose/Description Changes in equipment and price <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of F1 increase <br />El Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />Ri <br />F1 <br />1:1 <br />F-1 <br />El <br />1:1 <br />§11 <br />Dispersal After Approval <br />