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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REI VIEW REQUEST FORM <br />Date April 25th 2018 <br />Department Innovation and <br />Name Brian Donoghue Technology_ <br />BPW Date May 8th 2018 Phone Extension <br />Re u�ired Prior to Submittal to Bosurd <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller El and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F-1 <br />H Agreement <br />N Contract <br />E] Proposal El Addendum <br />M <br />Professional Services <br />F1 Amendment <br />El <br />Bid Opening <br />0 Bid Award <br />❑ Req. to Advertise F-1 Title Sheet <br />El <br />Quote Opening <br />R Quote Award <br />F-1 Chg Order No. <br />El <br />C/O & PCA No. <br />PCA <br />❑ Ease./Encroach. <br />El <br />Traffic Control <br />F-1 Resolution <br />F-1 <br />Other: <br />R <br />Claim <br />Company or Vendor Name <br />MetroNet Zi <br />New Vendor L Yes H If Yes, Approved by Purchasing <br />E No <br />MBEAA(BE Contractor [-] MBE MBE Completed E-,Verify Form Attached El YeNos <br />F� <br />Project Name Digital Access Sites <br />Project Number <br />Funding Source Innovation and Technolo Su lies Account <br />Account No. 279-0672-15-21-05 <br />Amount $0,00 <br />Terms of Contract <br />Purpose/Description Providinq andinstallinq new conduit and fiber for Martin Luther <br />King Jr. Center- See memo <br />For Chan qe ardor- nnl%i <br />Amount of El increase $ <br />F1 Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />El <br />El <br />F] <br />El <br />n <br />