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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />2018-02-22 <br />Rene Casiano <br />Department —Office of Innovation <br />BPW Date 2018-03-13 Phone, Extension 5897 <br />Required Prior to Submittal to Board <br />Legal Z Attorney Name Clara McDaniels <br />Controller z Controller review is required for all Contracts $5,0100.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />N Agreement LJ'Contract Ll Proposal L1 Addendum <br />F1 Professional Services 0 Resolution <br />F-1 Bid Opening El Bid Award El Req. to Advertise E] Title Sheet <br />0 Quote Opening F-1 Quote, Award <br />F] Change Order No. ❑ C/O & PCA No. PCA <br />F-1 Ease/Encroach. Traffic Control <br />n Other: <br />Company or Vendor Name <br />Kingswaysoft <br />New Vendor <br />M Yes El No R If Yes, Approved by Purchasing <br />MBENVBE Contractor <br />F] MBE [-I WBE <br />MBEANBE Contractor Requested E] No [:] Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />IT supplies <br />Account No. <br />27906724152105 <br />Amount <br />$5990,00 <br />Terms of Contract <br />Onetime license purchase — annual support and maintenance, if <br />desired <br />Purpose/Description <br />Software package to automatically update Dynamics CIRM data <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc,) <br />Amount of F-1 <br />F <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />F <br />n <br />F-1 <br />F-1 <br />El <br />0 <br />