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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/2/2018 Department Fire <br />BPW Date 4/0,18 Phone 9..255 <br />Name Andrew Myer, A/C EMS <br />0 Legal ❑ Attorney Name Elliott Anderson <br />_0 4- <br />(D Controller review is required for all Contracts $5,000.00 or more, <br />0 Controller ❑ and greater than one year in Ilength per the City Purchasing <br />Of "'I <br />(D E -0 CO0 Policy <br />u) Purchasing ❑ Michael Schmidt <br />Check the ADDroDriate Item TvDe — Reauired forAll Submissions <br />El <br />Agreement <br />E] Contract <br />❑1 [:1 Proposal I—ElAd"dendurn <br />El <br />El <br />E] <br />Claim <br />Bid Opening <br />Quote Opening <br />Chg Order No. <br />El Bid Award J-H Req. to Advertise ❑Title Sheet <br />El Quote Award <br />❑ C/O & PCA No. E:1 PCA <br />E:1 <br />Ease./Encroach. <br />El <br />Traffic Control <br />El <br />Resolution <br />❑ <br />Other: ther: <br />. .... ..... <br />Required Information <br />Company or Vendor Name <br />New Vendor <br />0 <br />Yes F1 No F1 If Yes, roved b Purchasing <br />MBEANBE Contractor <br />0 <br />MBE Ll WBE <br />Project Name <br />Project Number <br />Funding Source <br />EMS Capital Fund -Equipment Purchase <br />Account No. <br />287.0902.422.43-10 <br />Amount <br />$ <br />Terms of Contract <br />....... ... <br />Purpose/Description <br />Purchase of 8 cardiac monitor/defibrillators; will replace older <br />models. <br />For Change Orders Only <br />Amount of F-1 increase <br />El Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />% <br />PO No. <br />Dispersal After Approval <br />Copy Original <br />F-1 F-1 <br />El El <br />