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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE' QUEST FORM <br />Date <br />Name <br />01123/18 <br />John Martinez <br />VPA: Facilities & <br />Grounds <br />BPW Date 02/13/18 Phone Extension 7645 <br />.-Required Prior to Submittal to Board <br />Legal Attorney Name Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.010 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing 0 <br />Check the Ap ropriate Item Type — Required forAll Submissions <br />'EkAgreement Contract El Proposal El Addendum <br />Professional Services F I Resolution <br />❑ <br />Bid Opening Award El Req. to Advertise El Title Sheet <br />Quote Opening R Quote Award <br />El Change Order No. R C/O & PCA No. ❑ PCA <br />F1 Ease/Encroach. F-1 Traffic Control <br />El Other: <br />I.. — Required Information <br />Company or Vendor Name Network Solutions Incorporated <br />New Vendor [:] Yes Z No F If Yes, Approved by Purchasing <br />MBEANBE Contractor F-1 MBE F WBE <br />MBE/WBE Contractor Requested ❑ NoF_1 Yes Name ofCompany <br />_ <br />Project Name Morris Wireless Improvements <br />Project Number <br />Funding Source Morris Capital Improvements <br />Account No. 416-040-4463 36.01 <br />Amount $41,872.50 <br />Terms of Contract <br />Purpose/Description Wireless Network Installation- Increased Covers e/Ca abiI iti <br />Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of El increase <br />E] Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />M <br />El <br />M <br />F-1 <br />0 <br />R <br />Dispersal After Approval <br />John Martinez <br />Mike Sniadecki <br />Daniel O'Connor <br />