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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date ADril 25th 2018 <br />Department Innovation and <br />Name Brian Donoghue Technology <br />BPW Date May 8th 2018—.--.— Phone Extension <br />Required Prior to Submittal to Board <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing EJ <br />H Agreement <br />N Contract <br />❑ <br />Proposal H Addendum <br />M Professional Services <br />n Amendment <br />0 <br />Bid Opening <br />El Bid Award <br />Req. to Advertise Title Sheet <br />n <br />Quote Opening <br />Quote Award <br />F-1 <br />Chg Order No, <br />❑ C/O & PCA No. <br />❑ PCA <br />F] Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />F] Other: <br />F-1 Claim <br />Company or Vendor Name <br />New Vendor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms, of Contract <br />If Yes, Approved by Purchasing <br />1:1 MBE E Completed E-Verify Form Attached El Yes <br />F-1 WBE No <br />Diaital Access Sites <br />Innovation and _Technology�§upplies Account <br />279-0672-415-21-05 <br />Purpose/Description Providing hardware, SmartNet, and professional services for <br />Martin Luther King Jr. Center- See memo <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />El 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 Original <br />